HomeMy WebLinkAboutMortgage_Heldt (12)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
, s FOR DEDUCTION FROM ASSESSED VALUATION
• Siate Fofm 43709 (R11 / fi09)
S f Presoibed try Department of Lxal GovemmeM Firexe
INSTRUCTIONS:
To be filed in rson or b mail with the Coun Auditor or Coun Rernrder o/ fhe coun where fhe � �� �q
ve r n N ty c�vertr rs iowrea. D �nM
Fi7ing Dates: 7) Real Property: Mus161e durirg the year (or which Ihe deduclion is sought. Auditnr
2) Mobde / Manutactuled Fbmes rqt assessed as Real Properiy: Must fi!e durirg fhe hveHe (72) rtronths
before March 31 ot each year the deduction is sought Q�Cou^b Rerv�du
See �everse side fa additional inshuctions erM quald�cations. �
�i�
�Apprxant (owne� w qxpr¢t Duyer,� see�s on reverse side) A UDITOR
o�ria
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Address of rtiortga9ee 8�mntraU se0er
egal drsaipUm
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Mor�qage/Contraain
March 1, wrrem year
Name W assignee w other owner or htltler al mor[gaga
AEdeass of
�naiana?
sm1e,
No
ate bebw
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ee4 uly, sfate. aM i
ZIP catle)
ir y�..w,a� �mry,
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npaid as of Mortgage / Contract intleb[edrres
�dT of app6otion
C.J
If mmed wiM someone other than spouse.
C� V l.� i P���
unpai0 as d is Ne appOrant Ne sole
legal or(-e�qnuita"de bwne(.�
�yves ❑ No
�s Ihe P�D�Y in Ouestim: MnueOY AssesuV
eal RoPartY ❑ � �'
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D��a���er NO.n.�.b.°..9, -......
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Card \O. ..�. .....
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What Tari�g Dist � � � /
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