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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou owns v r
_,. FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn C3709 (R71 / 6-09)
��w Presaibed M� af la�l Goremme�ri Futv�ce
N�' eBfark CUIU
wsrRUCnoNS:
b be filed in permn w by mad witl' fhe CountyAUditor o! Counry Recorder o/ the rounty whele the property is located. F� �� ��
FNrg �afes: 7) Real Proparty Must 78e dwng the year (or which Na deduclion is soughL �,�p,�d�
2) Mo6de / ManufacNred Homes rqt assessed as Real Property: Must file dunng the hveNe (12J moriths
6efae Ma�ch 31 o/each year Ne deducGw� is soughG GIBS N N�W S4tOJde�
See reverse side (or additional inshuctions arM quel'dicafions.
Aoofre�n (awneraroontaC bu�w- see+
���Q��z•�a�i
ray, smm. aM LP mdeJ
R¢md numDer Pape wm6a
>� -b
icm+�meen��vabasm ism<ecW�mmsswe
Pfi�tim kgal or epWtade wmeR
❑ Yes ❑ No
sarmrne W�er Cun spw�sa.
v�wem �� o�essan: a,m�aoy Atsessea
� Pfopefi' ❑ ArmuaOyASe�ed
Mob�e Hm�e OC 6
n,�a„���-,�oaG�`�....:
AilCress of anignee (num6ar end street mY �e, an0 LP ootla) �
Ca1'd \'O.
... . 5
Does aPplxairt wm property in any dher If yes. �hiat oounfyt NTat Ta�o Q ' .•._� ...•. p� Q
counrymindana7 �1� .l._ ���Q�� 'yi� bS\
� CaSYes I YHO IC!—N