HomeMy WebLinkAboutMortgage_Georges_"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun1
+ FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Form 43709 (R71 / 6-09J
ti w. Prewibetl M Departmerd ol Loral GovammeN Fu�arce
INSTRUCTIONS:
To be tded in person w 6y mail with the CountyAuditor o� Counry Recorder o� the wunty whem the pmperty is located.
Fifirg Dates: i) Real Properfy: Must fila durirg the year Por which !he detluction is sought
2) klobde / ManulacNred Homes not assessed as Real PiopeRy: Must fiie dunng the twelve (72J months
betora March 37 of each year the deduclion is mught.
See reverse side for addifiona! instruUbns arM qualifiwtbns.
�� �W^lef °_r �C by�e� �ee reabiraon,sAn rave+se side) (� A/
�F� GI�SOY COUNTY AUDII
�/�/� r�j'� R¢mN mber Page�n/u'my0�er
-L�J I' J �.J �.i V
indebtetl�s unV� as d Mwtgage I Contraa uNebtedness �mG� as d b Me ePP�t ihe sde
r date o( appGCation kgal a equRade awnM
❑ Yes ❑ No
rc owned with sanernre aher ihan sP�a. mdimte rith wfrom
Is C�e O�VenY N Ouesnorc MnuaM AaesseE
� Re91 P(oPertY ❑ %+!�!�!!�Y �
✓
� lT'f'unly,�d'ISqp I O
❑ County Recorder
n�e�cn i. anrJn yrar I maTn i, airreni
It ro. what b ttis / her e>aG share of interesi7 ��
tl fwr�e m iemid is QRfeRnt Man Nat o( aPP��. triEirate bebw
Name of rtnrtga8ee ar contrati se0c
mortgage
(numDer eM svee4 my. s
UOCS B�UII[ GWf1 QfOpCRY N 811Y ONPl
couky io �ne'eriaa ❑ ves
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aM LP code)
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20 _ � 20 _
SignaMe W Camry Audhnr I Counry I Date (monM. daY. Y�A
I I We certify ulWer Ne penalry of perjury that the above a� foregoing infortnation is true and mrtec[ arW that Me applirant is a resident of IrWiara aM
r I mntraa buyer of the aforemerrtioned property on date applicabon is filed.
. . �uwTf�� �) n . �i _ . Date (nrmtli. daY. Yea�
iWy ezewteO Power af Atmrtiey or Oy IC 61.1-12-0.7
Oerson (numbereM weeL �: stala, eM LP code)
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