HomeMy WebLinkAboutMortgage_MacMunn""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fartn 437091R11 / 6-09)
�' PresvibeC by DepartmeM ol Loral Govemmerd Fnance .
File Mark
INSTRUCTIONS: ( � F�
To be filed in person w by mail with the CounryAUditor or Counry RecoNer of the counry where the property is lacated.
Fifng Dates: i) Real Property: Must (de durrrg the year Por which the derlucfion is soughL � County Audhor
2) MobBe / Manufactured Homes rrot assessed as Real Pmperfy: Must file dunng the lweNe (72J months —�/�� �� Recordu
before March 37 0/ each year the deduction is sought. s
// /
Sea 2verse sida /or additione/ ins7ruUions arid qualifications. G I6SQN CQUNT V AUDITOR
(owrerorcontraCb�r-seemslM�onswreyersesiCe) \' ' � _
Oistric� Key�ucnOerllegalCesrriptior
�k-C.rJ1�-� � - � 9 - l �o -
ed vaWe drea17�W�Y as o( Abrt9a9e / Contra
1, amnt yrar Mamh 1, arterrt y
ro.
If narne m n,md is ddterent Nan that o( appOqnt, "uM4ate belrnr.
Name ot rtior4jagee or contrap seller f�
AdEres of rtnrtgagce or oontract sWer (number arM streef, cdy. sta:e. aM ZlP «
9a-c��S
Q
It owned witl� someone Ulm Ihan
/7"C /�C -�l n�T-� .
Name ot assipiee w oNrJ wmer or MIEer ot mortgage
AdERSS o (num6er aiW 5tree4 �: s�ate. entl Z/P code)
�cv � - 3 —
Does a�qitant am property in any oNer It yes. �Mat munry?
muHy in Intlara?
❑ Yes ❑ No
COUI
D�uction approved in the amount of.
20 20 20 20
a.S A �
WAat Tap�g Districtl
��
�I I We certify u¢der the penalty of rjury Ihat Ne above arW (oregoing infortnation i
owner I mntract buyer ot the mentbned property on date appliration is filed.
y (2�mehlull me)
�\ '
XFu0 resident atldmss of appfrcant (number aM sLeeL�: state, aId ZIP ooda) �
%8735. /75�. ForT �t�ahe�r. ,,, 47�e
Person auNOrRed Dy Euly execwEd Power of Aftnney w by IC G7.1-12-0.7
person (numeer aM sfree; dry, sfate,
Reto�d number � Page numDu
riraNe av.+�eR
Yes ❑ No
spouse. U�d¢ate v+N>>Nwm
property in QuesGm: MnuaOy Asussed
�I ProPeAY Q Armually 0.ssessed
Has Nis deCU�on Eeen
for curtent yeaR
20 _ I ^^
� m u��'
A� �D���� �
��6I,0� (a�93
m prapeny
❑ No
3M1