HomeMy WebLinkAboutMortgage_Miller^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
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� $tate Farm 43709 (R71 ! bO9) �, i l� '
�• I P�rribed by DeV�reM W Loral Govemment Firance
°" File Mark
�STRUCTIONS:
Fortn N
To 6e ned in person w. by mail with the CountyAuditw or Counry Reoorder of the county where the property is located. ,,,___,,,((( �
Filirg Dates: 7) Real Pioperry: Must file dunng the year (w which the deductlon is sought � ' r
2) Mo6r7e / Manufactured Hortres not assessed as Real Pioperty Must fi!e dunng the Iwelve (72J rtanfhs
6e(ore Maich 37 oleach year the deduclion is sought. ❑ County e
See reverse side /or additional instrucrions and qualificatbns. TY AUDITOR
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�se7 vdue c( real P��Y �
Ma�U 1, tlr�e�V yPar
If no. what is his / tcer erart sharF
�ifl3fflC Ofl f2NR:6 �ClCfli I1NI
u�at or app&a,t, uidinm
O1 flqf(g'MJEC Of COflf(8f15C��Cf
Address af rtartga9ee ar
� w...... �fi Q�O,
,�
�/ Contraa irdebte7�ss unpaid a d
anent year
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Name of astignee or ahej owner or halder of rtqrtgage
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AAdress of a5signee (number and Stree4 my. sbte, and Z/P a
Dces applionl o.m proparty in any oNU If y�s,
munryinlMana? ❑ Yes ❑ No
appfoved c� the
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a ca�n a�a�wr
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NRmt Tanfg DisUia7
COUNTYAUDROR
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I I We certify under Ne penatty oi perjury Nat Ne ahove arW foregning intortnation is We anc
owner I mnVacl buyer of the afo2mentloned property on date appiicadon is filed.
Pe�SOn
aCylCfil.
perswi (num6erarM street �N, sfefe,
I:r^.^d
oia ��
btetlness unpaiE as d � w� owneR
�V ❑ Yes ❑ No
sPouse. i�Micate rith �Mwm
�RIs propertyinqueslion:N�nueMASUSSed
ea� PrOPeKY Q AMUally Asseaed
s Nis dMudion Eeen re9uested on OropenY
�� � ❑ Yes ❑ No
�I'a11'el' i�'�..."SY,'.�
. ........
Card NO. ... r.91,�
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Date (month, tlaY• Y�h