HomeMy WebLinkAboutMortgage_Garrett (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
y Stata Fwm 43709 (R71 / 6-09)
�,.� � ResaiGeC by �eP��nt ol t.aral Cwemmenl Frence
�NSraucnoNS:
To 6e �led in person or by mail with Me Counry Auditw or Counry RecoNer o! the county wheie the pioperty is ocat . �
Filirg Da[es: i) Real PropeRy: Must �le durirx� the year fw which the tleduclion is sought. � Counry Auditor
2) Mo6de /Manufactured Homes not assessed as Real PropeRy: Must file dunrg fhe fweNe (72) mont�g
befwe March 31 of eacA year the deduction is sought �� Z County Recorder
See ieverse sida for additional instructions and qualfica[ions. C. �. M,.�ua„�.�
App5cam(oxneror buye�-seere�_yu m//�/J� side) �� % ���/ � v�\
(T . /V /� � W // � (/`��- i�i�BS(iN !`ni ir,iT.. ..v _ .
o�smn
Asessea renie a rea1 PmPem/ az
MarU 1, pprent yPar
If no. what is his / her esact sl�are
egal desaiptim
"/8-D?-/d/ �000.
rctgage / Contract "udeb[eOness unpaid as of
mh 7, wrrentyeer _
It �wne on rtmd is tliRereni Nan Nat o! appGcant, indifate bebw:
Name ol morigagee or convact seller �
mortgagee or mnbact se0er
owner or
noaress or assg�e (numcer ena sveet, r�. sra+e, ana t�r
ffire,
tq5"�° .
.iM9� / Can�aUU viAe6i�
late ot appfrcation �
dN sarn�
Oce5 appliC2nt Ovm pop2rty in aery oNe+ / I If y¢5. whai COUnt�? I NTa1 Tarirg D'atn
counry in IMana?
❑ Yes ❑ No
FZ,�
Sigra4�re W
��
unpaiO az of Is Ihe appG�gnt Ne sde
legal ar equitade ameY.�
❑ Yes ❑ No
is me w�cem �� a�esnorr. nriru,aoy nssessetl
❑ Real Properry ❑ Mnualy 0.ssesxd
Dra���cr NO..��I,�,,....
Card.�. ..... `�0........
5�3 $onti e.\Oilk`A.�
20 I 2q _ I 20 20 I 20 _ I 20
_ CoumY Date (rtnivh. daY. lee�)
II/ We certify urWer Ne penatty of perjury jffat Ne above foregoing infortnalion is We and corteG and Nat the applipnt is a resident of Iridiaria arW
owner I mntract buyer of the afo2mentioned Property o ate aPWicalion is filed.
� �e (owne/s MI name Date (rtrnfh. daY Y��
Y reside adAress of applirant (numbe� aM t, rJry, te, �1 LP oode) � �
U,
Person auttror¢ed Gy Ouy esecutetl Power of AuomeY � M�C 61.1-12-0 7 Date (rtiorvh, day, yea�
MEr�s of auNarzed per.^,on (number aM street. ary. sfafe, antl ZIP code)