HomeMy WebLinkAboutMortgage_Mercer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ownship Year
_. FOR DEDUCTION FROM ASSESSED VALUATION �
S1ate Fwm 43709 (R71 / 609)
� Presaibed M�M of Laal Govemment Fuwice
� File Mark
INSTRUCTIONS: MAI� m
b be filed in person or by mail wiN the CounlyAuditor or Counry Remrder o7 Me counry where the properry is located. ,—, �
Filiny Dates: 7) Real Property Must fJe duriig Me year for which Ne deduction is soughG � L4� county Auditor
2J Mo6de / Manufactured Homes irot asseued as Real Property.� Must fiie dunng the tweHe (12J mont�� �%a(%
before March 37 0! each year the deductan is saght. "`L��� �%ounty Recorder
Se�ersesidefivadditmnalinstructbnsar�d�qyalfiwtbns. _ G�BSONCO ITOR
J.�.iT'�u:-
1"" �
I vahre af � RWenY as d
a�mn year
3i �5 �16 i h2! 0%d� S�10f8 0� III{PR
�ir��
Nat of app0on; 6Wkate below.
Name af mortgagee or mntract sNler
Pddress oi rtartgs9� � mntrad
Name ol assignee a dhc avmc
ud atreet �Y: s+ate. entl Z/P ootle)
- __'_ '�
- �v�' �.......
Dra���er NO...........
' a
- Card NO. . �!?a?g ........� .
_ � io5;3�� �.
zo
NRatTering
� ��0 �
as ot Is Ne epp6rant the sde
kgal or equllaNe oM+ien
❑ Yes ❑ No
wrtieorie dher Ihan spause. cM'rata with wMm
Is Ihe properry in pueslion: MnueDy ASSessM
❑RealRoaertr ❑!vmuaMwssessed
Has ihis dedutSm Deen rMUav� m p(opelty
�� �� � ❑ Yes ❑ No
p— I p— I p
_ ��ry � �,�. �'�'-/ �-/ O
I I We ce-� und � a pe Ity of ry at the above arW foregdng infwmation is We end correfY arM that ihe applirant is a resideM of IrWiana antl
owner I contracl r of the ahHe `rtioned properry on date ap�'ication is filed.
I (ownef: !u0 name) �� lK/ �/ l. �� (�• daY• Y�A
p let �of O�/�(numDeranESlree4mY��n/rU( a�'� (�/�JVO
S � ,�, -,
� ew,� o� ae� �,�a aw« arn� w n� ic s-,.,-,z�., oa�e a�. �r.,�d
o( autlior'ved persa� (number aM sbeet, dry, state,