HomeMy WebLinkAboutMortgage_Michel^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
:• Stale Form d3709 (R71 / 6-09)
S -�f Prescribetl by DepartmeM ol Local Govemrtrenl Flrence
� File Mark
�NSTRUCTIONS:
m fil
To be filed in person w by mail with Ihe CountyAuditw or Counry Recorder o/ the county where the pioperty is focated. MA '
Fil'rtg Dates: 7) Real Properry: Must !le during the year (or which fhe deducGon is sought. unry AudiWr
2J MobBe / Manufactured Homes rrot assessed as Real Property Must file dunng the fweNe (12) months C�
6efore March 31 0/ each year the deduction is sought �' R�O��
See 2verse side /or addifional instructions aM qval�cateons. GI BSON C
MP���t (awner or oontrarl buya�r -� se7e re�,s/lr�ictiwa% m� 2�ve�rse� sQi1e�)�� � /� •
W T i/v � v1.0/`^.^"'� (,,(�
Taung OistriU Key �umiber / legal desaiption Reco�d number Pege num0er
��'/7— � d0 -oo . 7 -D Z-
qs�,W rdue eeal ot Mortgage / ContrxG iMehtetlness unpaid az of Mortgage I ContraC intle6tednes5 unpaid as ol Is Ne applipnt the sde
�,�yU 7, � � RWrch 1, n�rtent yeer date of appGOtion �egal a equitable ovmeR
I( ro. what ¢ his ! her esad shara of intrml?
Ii tame m recotd a dRerent Nan ihat af app6carLL. udka;e belrnr.
Name af rtnrt9a9ee or mntraCt seYer �/ �
Addiess of mrnlga9eP w contract seAer (num6er eM sfreel, crty, sta�, aM 2
Name of assignee w oNer owner or hdder of mortgage
Ada of assignee (number aM 4 bry. sfate, and ZIP cade)
T (s� � � , �'� �
Does eQplirant w.n property in any oNer If yes. what munt�/l
oouHy in IndFaru? n Yes ❑ No
ction approved'c� the amount of.
20 _ 20 20
SigraWre of Gour.tYAUa�mr
I I We certify under the penaly
owner / contracY buyer ot ihe a
Sip �e(o fiArume
k ii�`�� , /3, c�
Pelwn autfroraed by duty esewted
Pddress of author'ved person (num
� ❑ Yes ❑ No
If owned wit� someo�re dher t n spouse, iMirate with whom
Is Ihe ProO�Y � VuesUCn: Mnua�Y Assessed
❑ Real Pmae!ri ❑ !vmualN Asaessed . .
/�4 L
�_\�7�71GT7
20
I'l���c. � C'.!-�+R i.c.. f c,�
{�,....�na A
Ia�ao��
20 _ � 20 _ I 20 _
� I��ry I Date (monfn, tlaY. YEa�
above ard foregning infortnation is we and correct arM ihat the applican[ is a resident of IrWiana aM
roperty on date appliption is filed.
, � Date (nmlA. daY• Yaa/)
tily, slete, arM Z1P oo-
v;
i or W IC 67.1-12-0]
ciN. state.
Date (morilh. tlaY. yea�