HomeMy WebLinkAboutMortgage_Shaw"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun T wns r
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• FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 609)
�' ,,,, � Preusibetlq'�epartmentolLOralGOVemmen[Rrance �17� a��Q��
INSTRUCTIONS: 6o�m
To 6e filed in person w 6y mail wifh the CountyAuditor or Counry Recorder o/ fhe couniy where the property is located. �� J.
FB'mg Dates: 1) Real Property Must fife dunng fhe year for which tha deduction is sought � d'rtor
2) Mobde /Manufadured Homes irot assessed as Real Pmperty Must fife dunng the nvelve (12) months
be(ore March 31 o(each year the deduction is soughG GIBS N�NGy°71S�WFl�@�
Sea reverse side for addilional inshuctions arM qualfications.
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Key numher / legal description Remrd num6er Page rwmoni
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W�Y ��py 9e / Contrarl inde6ted�ress un0� as af Mongage / Cantraa trWeMedn�s wPaid as of Is Ihe aPP�� the sde
Mard� 7. wrtem Y� date oi aGP��+ � ar eWdaNe oxnM
❑ ves ❑ No
��rt share of inferest? If avmed wiN someone Uher ttan se. i�imte wtth wiwm
Rerent Nan Na� o( aDP�nt. IMip[e below. I �he Property in QuesUOn: MnuaDy Assessetl
Real PmPeRY � ?�!��!�Y � . . _
►ume m rmtgayee «cmo-act seuer
nddress ot rtnrtgagee «mno-aa sen
Name o� assignee w oiher owner or t
Address ot assi9rree (number aM str�
stree4 �Y, sta�. aM ZIP oode)
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ciy,sfate,antlZlPC_'_.__y.—_ _ _. ._ _ .._ _ __ _ _—
pvm pmperty in any oNer I If yes
a� ❑ No
❑ Yes
In ihe amouN
zo I � I Zo_
that Ne at
ned prope
autho�aeG Cy duty execvted Power of Attomey rn by I
; af author'ved pem.on (num6eraM sneel �: sYdle.
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