HomeMy WebLinkAboutMortgage_Campbell (2)Y—"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
s FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
, l Presvi6etl by DepartmeM of Loral Government Fnance
INSTRUCTIONS:
To be lrled in person w 6y mail with the CountyAUdROr or Counry Recorder of the county where the pioperty is located.
Fifilg Dates: 1) Real Properry: Must file dunrg the }rear tof which fha deduction is soughf.
2) Mo6ile / ManufaUured Homes not assessed as Real Property: Must fi/e dunng the fwefve (72) monMs
before March 37 0( each year the deduction rs srought.
See reverse side tor addi[ional instrtictions arM qualifrcations.
Y I" � - - • ed '
vWue of real poperty az W htortgage / Contraa indebtedness unpaid as of Mortgage / Cm;
MaiM 1, arre1G ym Maich t, w�rent year date o( a p�fimyt�i
W�
II no, what Is his / her e�ct share of interest? If awned wiN mmeorre otl
It name m �ecwtl's diArlent Wn Nat a( app6cant, inCirate bebw:
Name of mortgagee
contraU
Name ot assignee w oNar owner or hdder of mnigage
AdEfess of assignee (num6ereM strret, (riy, smte, and ZIP code)
Daes eppiiont am pmperty in eny other If yes, what wunty.�
caunrymind'ana? ❑ Y25
❑ No
20 � 2Q _ � 20 � 20
[�E��ry$� °i�9�4
� I kgal w ewitade ameY.+
❑ Yes ❑ No
spouse, IMicate with whom
Is the P�GenY in question: MnuaM Assesse0
❑ Real Pmperty ❑ MnuallyAssessed
�O
i .
.. �.....
��T��o� Di•a���er i ........
..
�1 �� .........
woROa card No. ... ........
� �ay,�.��
_ �20 _ 20 _ 20 _
Signanne W Cam�Y Auditor I Counry I Date (month. day, laa�
I/ We certify u�er ihe penalry of perjury that the ahove and foregoing intortnation is W e and correct and Nat Ne applirant is a resident of I(Wiana and
o�mer I wntract buyer of t�e afwemeMioned property on date applicatlon is filed.
Si9 (orne/thmrameY il I Date (rrmfi. day, yea� _
Person auNOr¢eE Ey duh/ exewted Power NAttorney or bylC 61.1-12-0.7 I �ate (monN. day, yea�
AOtlress ot authomEO person (numberaritl sLeet, city, sbfe, en0 LP code) .
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