HomeMy WebLinkAboutMortgage_Mobley^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
; FOR DEDUCTION FROM ASSESSED VALUATION
`r"' . �
S1ate Fwm 43709 (R77 / 6-09)
�' �.r � PresaiCeC by DepartmeM of Lncal Govemrtrerd Finance
de Mark
�NSTRUCTiONS: q
To be �led in person or by mail with [he CountyAUtlitor or Counry Recortie� o/ the county where the property��t6tl.9
F�7"mg Dates: i) Real Property Must file dunrg the year for which the deduction is sought.
2� Mo6de /ManufacN/ed Homes not assessed as Real Properry: Must fiie dunng the tweNe (12) mo�
before March 37 of eacA year the deduction is sought.
See reverse side for additronal instructions arM qualifications.
i
Md�ni.(qwntrorconf2gDuye�'i�?T!^''�'S�PreY9�iP��e) / � .
� fi�d wiN:
� CounryAuditor
❑ Counry Recorder
J Key rnunber / legal DesaiDUm // � Remfd numhel Page nur.ibel p
(o- -Z o Zoovooa �33 �
p�opaty a d A1oROage / Contraa indebtedness unpaid az W Martgage / Contract i�Webtetlr�s wpaiE a d Is ihe appcant Ne
Marr}� 7. n�rtente�C ' / Eate af appGCatpn legal w rtade ownM
x• ���y ❑ Yes ❑ No
If ro, what is his / her e�
If owned wiN someone Whar Ihan spouse. iMicate with wlom
If name m remd is tliflerent Ihan Nat of app6�ant, uW'uate bebw. Is U�e property in puesaon: MrwaOy Assessed
❑ R�i �aero O n„��y w�
— - — - - .- - -- -- — - -• ro� oc s
Name ot mwigagee or mntract selle . ^
(^/ ___ ' " 1 /I
Address d mart9a9ee or conbact se
� (J�i rW"'
Name ol assignee w aher owner or ���r 1� V
ACCress of a,ssgnee (number and sn
Does aPplirant own property in any c
munly m IMena?
❑ Yes
artaunt
20 � 20 _
��5, ��4 `�
��-��a5
I m property
, ❑ No
20
1/ We certify under the penalty ,,, „�,�.,�� ,.�e. o�� ew.e a�ti �.nayuiny nuurrrwuon is we ano cortea ana ma[ mA appupn[ �s a resaent o( IrWiana ard
owner I mntract buyer of ihe aforemenlioned properry on date applicalion is filed.
I�aNre.(ow+le/s hN nemCi� � Date (montli. daY. yean
OydWy
state.
and
61.1-72-0J
Date (monih, day, yaa�