HomeMy WebLinkAboutMortgage_Roberts (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Trn
__ s FOR DEDUCTION FROM ASSESSED VALUATION
• Sfata Form 43709 (R71 / 6-09) —
,• / PresaiCed by Departmerd a1 Lnfal Govemmeiri Futaxa
Fl
iNSrRUCnoNS:
To be filed in person or by mail wifh the CountyAUditof or Counry Recorder of the counry whefe the property is bcated. Fortn hle
F�irg Dates: 1) Real Property: Must fila dunrn� fhe yrear for whifh fhe deduction is sought 1
2) Mobr7e / Manuladured Homes not assessed as Real Property: Must fiie dunrg fhe tweHe (72) monfhs A 1
be7ore March 31 0! each yea� the deduction is sought.
C.'J.
See 2verse side for add�ilio � strucGons and qualifications.
AppGtant(ownerwmnnart6' �- _ onre siie) _ GIBSONC
�_['�'u=^u�
af is his / trer erafl share ol intelestt
m �ecad is ddfe2nt Ihan that af aGP�t uW'uate heb�r
Nam¢ W rtqrtgagee or contraG uller
Pddress oi nqrya9ee or wntract se�er (nurtibv and strae4
Name W assignee w oNU ovmer a halder W mortgage
AGCress ol assgnee (numberand shee4 �1: stete, arM ZIP code)
Ooes a�imnl own popeny in anY �� I( yes. wha[ munty7
couM' m InOa�a? r-� __ r-i _.
20 _
Sig�aWredCO ry
I I We certify unc
owner I contrad
amount
�unry Auditnr
Counry Recorder
� OUNTY Hvui i uK
Remrd numMi Page numbu
- -� �-C2� l. So 8-p l I 1`7
e0ness unpaid as W Mwtgage / Contrac[ uWebtedness unpaid as d Is Ne app�ant Ne soM
date ot avd�� �gal w eWttade or+ieli
�O� ❑ Yes ❑ No
H oxned wNh someane other than spouse. hdica[e wfih v.Mm
Is tl�e WCO�Y in Question: Mnua%ASSessed
❑ Real ProPenY ❑ %�N �
far
m prapeny
❑ No
_ 20_. . �, �— �. 20— �20— �— p—
nry Date (monN. OaY.1��
D 1'a 11� e r N O...� I J,,,,,,,, � is true and cortect and that the applinnt is a resident of India� aM
I.
Address ot authu'ved per'..wi
C�rd NO. ...... � .l..cJ.........
ii�s� 6��
d Fbwer o(Atmmey or by IC 61.1n2-0.7
m6er arM sbeef, dry, stefe, aM ZIP mde)
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