HomeMy WebLinkAboutMortgage_Doerner"•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,,. � FOR DEDUCTION FROM ASSESSED VALUATION
� StateForm41709(R77/6-09)
�,.�. � PresaiEetl by Depanmertl o( L�I Govemmem Firence
INSTRUCTIONS:
To be �ied in person w by mail with the County Auditor or Counry Recnrder o/ the county where the pioperty is located.
Fifirg Dates: 7 J Real Pmperty: Must file durirg Ne year for which the tleducfion is sought. �
2) Mob�ie / ManuFactured Homes rwt assessed as Real Properfy M�st fi!e dunng the hveNe (12) months
befae Malch 37 of each year Ihe deducdon is saght.
See 2verse side fnr additional 'nstn�clions arrd quali�cations.
nppfram(ownerwconvarJ JaaSre ' mmrersesile) � � , GIBSON
��� I ��►5
Assrssed raLe d mal pmperty a ot Mortga9e/
Mardi 1. ammt ytar Mart�h 1, a
�� Iq� W�1dI6 �15 � i12f 0%df2 Si2f8 Oi III(CRSI�
tt(wr�e on recorti a Eirterent �han Nai of appYCam, uMicate Eebvr
Counry Recorder
7
- �oo-� . �-oa5 `�'"� ��e ay8
tednnss unpaid as af Mw�yaye � co�raa maeecee�ess �noaa as a Is ihe appfifant Me soie
/— Eate o( appfiration legal or eQUNaWe vwne!!
l(JS O ❑ Yes ❑ No
� If wmed with someorre oNer than spouse. ind'xate wflh whom
w mntracl seDer (nun6e� and stree; cfi: stam.
or othr! avmer or hdder ot mwigage
AAdress ot assignee (number aM sfree4 ary, slafe, antl Z/P tatle)
/
Ooes epplimN own yopeRy in any oNer If yrs. what cour'
tounty m InC'ar�a? /O N
❑ Yes ❑ No
�r
- �
Dr�urarn aowwed in the amount of.
20 I 20
1 I We cer�Yy under tf�{ penal
amer I contract buy�r.bf the
7reWre (own4fs �0 name)
-�� �aa�
Q�l I Counb �1I�/"�MU-l/� I oa�e (� �� (�I —�/ /
r ,
.� foregoing infortnation is W e and cortect afM that Ne applirant is a resident of I(Miana and
on date application is filed.
Date (rtqnfh, day, yaa�
Is Me P�PenY in Ouesfim: MnueDy Assctsed
❑ Real Property ❑ MnuallyP.ssessed
ro. a,ere,n yean
20 � 20 —
requeste0 on proprriy
❑ Yes ❑ No
`-lC� 3� S � �fd�
aWroReE Dy C�ey exeated Pw.vJ of Av«ney w Dy IC
20
anAZlPmtlej
AAtlress ot autltIXrz¢d person (num0eraritl sbe¢f. city. SYdtC, aM [IV mtle) ' I�