HomeMy WebLinkAboutMortgage_Fuhs"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE o s Year
__ _, FOR DEDUCTION FROM ASSESSED VALUATION
- Sfate Fortn 03709 (R71 / fi09)
,' �w PresviEetl by �ePM�nI W Laral Govemmerrt FinenCe �
wsrnucnoNS: JUN 1 y ��`�`
Fartn Ned with:
To be filed in person w 6y mail with the County Auditor or Counry Recorder o/ the counry wFiere the properry is located.
Filing Dates: 7J Real Property: Must file dumg the year lor which the deduction is soughL � Counry Auditw
2) Mo6�7e / Manu/actured Homes rrot assessed as Real Property Must file dunng the hvelve (12) s'�j}
before Ma�ch 37 oleach year the deduction is sought. pIBSON COUN Y A I�unty Remrdw
See reverse sitle 7or addttional instrucGons arM qualificatrons.
AmGramlo�GJbrormntr�a`Yb -mere miawrsesidel•. � .
"`�^q,,s'.n �1C b^
Asessed rahx d real PoP�Y as ot
A1aIU11. anrnt yPa
tt no. what b ha / her e� share o/ intmest?
If nartre an iemtd
([ _4e1=�� ` �Q' �. � �� _D� Rem�d Pape
7�
Mortgag e/ CantraC. inde6tedness unpaid as d Mongage / ConCac[ IrWebtetlness unpal0 as of Is Ne epp8rant ihe sde
Ma�W 1, w Eate of apP�� legal a W�itade axneYl
❑ Yes ❑ No
tt awned riM mrneane dhar Ihan spouse. 6dKate wtth xirom
. Indicate helrnr. Is �he p�openy in 0�: �nuaDy PssesseE
❑ Real ProPertY ❑ A^^uallY 0.ss�sed
Name m �rotgapee «mntrxt senn
�
Pddress of nartgagex or mntraG smer (nun6ei and sbee4 Ufy. state, arN ZIP code) _ �
Name ot assignee ot Whu ovmer a MIEer af mort9a9e .__ ' "-- ".
�d�a,����,���.«n.��.�Z�P��_ . .. Dra�r�Cl� 1\i�...p6W+AJ.......
OOES E
Ql11M1h
il��
Card NO. .....�Lv�.......... �'
'�Sg00�•� —
20 _ � 20 � 2� _
I I We ce' under the penalry of perjury that the above :
own con , buyer of the atorementi ed ' erty on
(o.mer3 � reme)
' QrdeC� oa fxani ran0s e dly,state,an[
V
rsm auNaisd Dy OWY esewteE Powe� of ACbneY or M IC 57.�
pem,on (numDeraiMSbeeL
Counry
��7
�
�Y. Y��)
.��
r ��
infortnatlon is We and cortea arW fhat Ne applinnt is a resident of IrM'gna aM
ion is fileA.
�' Date (month. dzY Y��