HomeMy WebLinkAboutMortgage_Wagner^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o Year
..-_—.
FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 609)
�,,,, � Presaibed by �eparlment o1 Lod GwemmeM Fuiance A P R 4
�israuCnoNS: ���a�
b be filed in F� �� �:
person or by maii wiN the CounryAuditor or County Recorder o! fhe counry where the pmperty is located�. -
Filing Dates: 1) Real Property: Must fJe during the yearlor whi�h Ihe deduction is soughL Counry Audimr
2) Mobile / Manulactured Homes nof assessed as Real Property: Must fi7e dunng the tweNe�;�ItrwNths ��unry Recorder
before Mamh 37 o/each year the deduction is sought. ��� COUN Y q ITOR
Sae reverse side for additional insWctions and qua/ificafions.
f vah�e a real waam as a
dmeb yrar
�-
Key r/ legal d Uon
�' - Q�'
�ge/COntraU
1, artent y�
If ro, whal's his I her exaR share ot interest?
It rame on iecad is dfiemst Nan Ihat a( appGrant uid�
Name of rtwrt9a9ee ar ����(../
� �
Add2u of rtnrtqagee or cantrad (numDe� and
Name of assi9nee a other rnmer m hdder M mort9a9e
AACress ot assignee (number ard street �Y. �.
� a���� ��
m�,Hy �� i�dm,a? r
20
ves u No
�
wnt oE
N '
rate beb�r
s�4 �: state. aM,
arq ZIP cotle)
���.��W���
�
�
� Remrd numDer Pege number
��
as N Mortgage / ConVacY mEehtedriess unpxitl as d Is the eppGont Me sole
data o( apP���� I�al a equttada ovme(1
n Yes ❑ No
If owned wiN someone oNer Ihan spouse, indi�ste weh vAwm
tM V�oP�Y in Ouestion: MnuaM Asesud
}j2eal RoPertY ❑ Mmually A�sessed
Mohde Fbrtie (IC 6
���� �%7�N �- _.
� Ac�yN M
20 _
ZO
�a - �5� �
��,�
, o�
20 - � 20
Date (monih daY.
I I We certify ufWer the penalty oi perjury that Ne ahove and foregoing infortnalion is true and corteU and Nat the applirant is a resident of I�iare ard
owner I contrad buyer of the ato�emeMioned property on date application is fiied.
imn�loJnuinnh RArumal �� (�^�. daY• Naa�
riry, sfate.
Pe�son auNOrrsed Cy duty executetl
W aWiaaed person (numDer aM streeL dry, state, ard LP cotle)
0
��