HomeMy WebLinkAboutMortgage_Atchison* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou T s ip Year
FOR DEDUCTION FROM ASSESSED VALUATION '/
� � $tate Fwm C3709 (Rt t / 6-09) `
�` P'esQibed by DepartrtieM of Local Govemmera Firw¢e
wsrRUCnoNS: OCT �P1e���
Fam Ned wiCc
To 6e filed in person or 6y mail wiN the CountyAuditor or Counry Recorder of the counry whe/e fhe property is located.
Ftihg Dates: 7) Real Property. Must hle during Ne year for which the deduction is soughL �ry Audhw
2) Afo6i7e / ManufaUured Homes rat assessed as Real Property: Must fife dunng Me twelve (72) months n
6e(o�e March 37 o/each year the deduction is soughG GIBSON O Y u��
See reverse side (or d' nal instnrc.tions aM aualrfiFations.
KeY numEer
w� vaeie a popenY as
MaNi 1. wrent �
tt no. what 6 Ivs / trer e�G share
tt �urtre m recoN "s dAfxent tlian
�'i��
Address of morcgagex a mnvat2 sWc (�r ard streeG �y. sta
Nama oF assignee w aMi owrer or haldrs af mortga9e
Pddress ot ai9�88 (numEer ard atree( ttiy, sfate, antl LP catle)
Dces ePW�� own P�O�Y in an)r oNer If yes. what
T����D
Deducaon �pro+ad 4� the amount
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penatty of
of Ne afw
ofapp6rant
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Page
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1 as U Mongaga / Cantrart mEebtedness unPaitl as d Is Ne eP�� tlx sde
Cate W aDP� � a eWitade rnmeYl
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N wrtied with �mmne dMr Ihan sCa+�. udirate with whom
Is IM OroO�Y in 7uesGm: MnuaOy A�sM
❑ Reai ProperA' ❑ almi�aMassessed . . _
Mas Ihis deduaim Deen re9u�teG m piaputy
for amva YeaR rt .. �--�
COUN7Y e� ��T^°
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20 _ 20. ` "(� �—
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the above and foregoing in __,� —... _,., v�.ent of IrWiara aM
orocertv on date aoDliratia _ ..._...
Pasm a W�a� Dy didy exewtetl Power W Amrney a Dy 1
AOEmss d aulMrvetl 7e�^';n�mbe� arM sbeeG �Y. sfa/ta.
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