HomeMy WebLinkAboutMortgage_Gates.t ""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RB / 2-07) ��j�i � 1
�' .�u � Prescnbad by DePartrnenl of Local Govemment Firiance 1� yJ ,l,' �"'"� j '
�� File Ma
INSTRUC710NS:
To be filed in person or by maa wiUi Me CountyAuditor o/ the county where the properly is bceted. � Q N 1�7 ZQ�9
Fding Dates: 1) Real Proper(y: Dunng the 12 months be/ae June 71 d fhe year the deduction is to be eflac6ve.
2J Mobde Homes assessed under !C 67.7-7: Befween January 15 and March 2 07 the year the deductior�is to be eflective.
See reverse side for edd6o ' truUions and qualifications. G%fy� ��1 .
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qppicam(ownerorm - strictiansmreve sid V� 50:J COUNT'( :.UDITOR
T' i�d KeY num6er / I U� I n-� _� t Reeoid ntwber Page rn�mber
uepf pppatyas N�f,ae2nlyear Abrtga9el inde
aM
artent �
if �nat is his i her Pxaa:�r� m imeiest? �
If reme m recwd is difterent Ihan thal of applican4 ��i�ate bdaw:
Nartre af rmrtgagee or canUacl sdiu C
�
wdm� o� �,oneayee «oo�aaa sd�. (numars ano sneec dry. ��a. a,�d zra coee�
Name of r-av�ee u aher wmer a hdder ot matgaga
�_ ,
qEdr¢ss � ' ""'M Z!P code)
Doesa� �I':111'CI" 1�7QO�(�•.��/� ""�h?
county i
20
C.IP(� 1�'0. .
and
If
�o�f. 8aa-a�/
unptid as of March 1,
sortreone
What Ta:ing Districl�
/n1�1�7167:7
Is ihe appfipnl lhe sde lega� or eq�ntade ownert
❑Yes ❑No
spouse, indicate wiN wfiom.
Is tha property in quesUm:
❑ Real Property ❑ Mobile Home pC G1.1
; this detludion been requested on yoperty
wrre�l r�n
❑Yes ❑No
2p [u 20 20 20 20 _
�, cumq oate (monm, oar. r��
the pen ty of pe� ry ihat e above and foregoing infomiation is true and cortect and that ihe appGcanfs was / were a resident of
of tlie aforementimed p eAy on March 1, 20
,,..,� _ . Date (mantn. day yea�
residenl address of appli�yht (number
' '� / / yb c.�
on auiharized by dury ezewted Paver
�ess of aNhor¢ed persa� (number am
by
ZIP
aM Z!P oode)
�V!//L�C� � ��v
Date
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