HomeMy WebLinkAboutMortgage_Rhoderick_@STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C T� ear
FOR DEDUCTION FROM ASSESSED VALUATiON �
SUte Fwm 03709 (R11 / 6-09) �
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To be filed in person or by mad witA fhe CounryAudhw or Counry Rerorder of fhe wunty where fhe properry is bcated. —
FrNng Dates: 7) Real Property: Must file dunrg the }rearlor which Ne deduclion is sough[ %° � Audiwr
2) Mo6�7e / Manufac2red hbmes raf assessed as Real Property Must file dunng the fweHe (72) months /
6eforeMaich37o/eachyearthededuc0onissought GIBSONCO T1CA�7��er
See reverse side (or additiunal insLuctbns and qualfications.
M0�1lownerormitrartbuyer"seeresbiftais .ersesitle) 'n
Tav'g �istriti Key �wwmbu / le9al drsaipnm
-/ —O�-d�o-oO�
Acxssetl e d mal qa ry as d Mortqape I Cantract indebtedness unpaiC az
Merth 1 1� Marrh i cyrte� O O O
a
rcm.whatSNS�ne.eoasharem�te��sn �rcw
tl nartie m amd s eirterent man that ot appucant. Ina�te oeim�c
Name of a crntrarl se8er /_
�YC
pCdress of rtnrtgagee or contract se�er (number and stree4 �1�i:.smte. aM LP code)
Name N assignee or afrei owner or holder ol mortga�e
AdCress N asvryiee (wmber and streeR dry. sa�te, and LP cotle)
Does appli�nt own pmperty in a�ry oMtt I( yes. what munry?
counry in IMana? ❑ Ye5 ❑ No
coun
De�uUm aowwad In Cre amouN al:
�_ I �_
� I I We certify ur�er Ne penatty of q
owner / contraa buyer of ihe aforen
` slp�Wre(oMriefshIDreme)
L
� rPSident t(nu r�
erson aWwraed M duty wcecuced Power
MCress of aWnmsA Ce�w�
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2p _ � 20
R¢mrd number Page rum�brr
7/ O- O 3- o?O / 0 �ao?3
d � �� �e��� ��b � � � � � ��
❑ Yes ❑ No
wiN sam,rone otlmr Nan spouse. uid�te wiN wfwm
Is ihe property in Que�gG}g�� ,M,,,nuaOy Asesud
❑ Rea� PtoPenY y x". ".'ua1lyA�ssed
Dra���er NO....(°�..OI�.......
� ��a3 �
❑ No
- Card �O . .....................
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oa�e (no�en. dar r�d
F4�i
Ne above and foregoing infortnalion is W e enC cortect and Nat Me applinnt is a resideM o( Iridiana ard
property on date application is filed.
_ Date (nronfi, d3Y. YeeA
�
eM LP oode)
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