HomeMy WebLinkAboutMortgage_Price""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _: FOR DEDUCTION FROM ASSESSED VALUATION
• State form 43709 (R71 / 6-09)
�,�,. PresaiEeA M DeDaNr�eM of LoW Govemrtrent Frence
File Mark
INSTRUCTIONS: M
To be �ed in person or by mail with fhe CountyAUdiror or Counry Recorder of the county whe2 the property is located.
FJ"mg Dates: 1) Real PropeRy: Must file dunrg the }rear Por which tAe deduction is mught.
2J Mo6Ae / ManufaUUmd Homes not assessed as Real Prnperty.� Must file during the hveNe (72) months C
be(ora March 31 of each year the tleduction is stuight.
See reversa side !or addilional instructions erM qualificatbns. G(BSO�
AppYan�iowrrer ormnvaa Du}�r � see reSncG'ms �iavarse side) '' n '
Auditot
Recorder
KeY ��� I le9ai desaiptim 0 �" RecoN number Page numbrl
-�-e.PR.� - - o�F- aoo. i-o a� ao// �
� 2al pfapMy as N 'Mwtpa9e/ ContraG irqe6teEness unpeid es at Mortgage I Cantracl mAebteOness unpaid az of is Ne eppG�ani tha sde
ymr March 7, frent yesr date o( aDW��� �gal w epuitade oxnM
�.S' O n U ❑ Yes ❑ No
if (wne m rcmrtl e dAfuent Ihan that of app6iani, triEUate Delow:
Name of nKVlgagee or mntracl seller
Addtess of nwrt9agee w mntrad
Does epplifant orm pmpeJty in any oUer
munryinlndana? ❑ Y�
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aumDa� an� streef, ciry, slate, arW ZIP code)
ar M nqrt9age
tlry, siste. end ZIP � � /
7
If yas. what munp?
❑ No
:;��
sg�c� w c�y,wart«
C _ T .
I/ we cerUfy under the penalry ot perjury at ihe above a
owner I convad buyer of Ne aforementioned property on
SiareWrafowne/sfiNnamal-. / /J
FuOresdenteddress
sfate. antl
�. ��� � �,
Is P�7enY in 7u�oon: Mm�eOy Assessed
eal ProPeRY ❑ ����Y �
wnatTa�dngorstrict' ]�1':11{'C'!' 1`' a�0
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zo _
_ c8t'd l�`o. ...� �i/�
2� � � 6, 3z � ��. ... ..
oare (r�mm, ear r��
regoing infortnation is W e and cortect and that Ne appfirant a a resident of IrMiare a�
appiiradon is filed. �
Oate (rronfh. 08Y. Yea�
y
exew:ea aoweraauwner
Pdtlr�s ot auNOr¢e0 peison (num6er aM sbeet u}: sta�e, antl ZIP cadej
Date (rtionN. Eal: �ea�