HomeMy WebLinkAboutMortgage_Wells"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ s FOR DEDUCTION FROM ASSESSED VALUAT� ��g-�
3 • State Form 43709 (R77 / 6-09) B'�
� � P2saibed by �ePartment of Lncal Govemmenl Frence �J
File Mark
INSTRUCTIONS: CCp ZO�� F�,�u�a�;,n:
To 6e filed in person w by mail with the CounryAUditor or Counry Recorder o/ the ao�nry WAe4e t�e pmperty is located.
Fi6rg Dates: 1) Real Property: Must fi!e dunrn� the yrear Por which tha deductan is soughL Coun Auditnr
2) Mo6i7e / Manufactured Homes rrot assessed as Real Pruperty Must file dtln'uij months h
P��; before Ma 37 0! each year the deduclion is sought ������� Counry Recorder
I�
Seereversesidefyta�l�ionalinshuf�tion�arMquali�c�tia�s. � ,,,QCnNCOUNTYAUDI'fOR
sessed ralue d real property as of Mpt(g�g e/ Conn
ard� 1, artenl year Ma�ch t, curtenl
m. what fs h"s I tcer e�or] shara oi int�t?
name m rtmtl s�Rerent Nan Ihat d aPD�C ciCUate Celovr
�9a9ee n wntract
7��' ���_�(.`/ . C.`-�l ^.,.� Reco`dnumberL I P„JnJ U`�
'C..r7.�-
"udebtedness unpaid az of Mortgape / ConvaG irMeMedness unpaid as d Is ihe aOP�m^i the sole
�,�/1 � wI6'Y���� date of eppliration � legal w equitade ame/1
i( / `-� V ❑ Yes ❑ No
tt awned wrth somearre aher ihan spouse, indi`sfe with whom
I5 Me DroVeRY in 9uestim: MnuaDy Assessed
❑ Real RoPertY ❑ Armually Assessed
Modle Fbme OC b1.1-i
Adtlress of rtqrtga9ee ar contratl um. �_.—• _—. bte. aM LP code)
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ll,�:�„���� �o=' 3380
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�a�,yo�. ._
oe
zo I zo
af
I I We cerUfy urder ihe pena7ry of
amer I contrad buyer of �he afon
Person autharzeE M d�AV ezennetl
ra. .irr�►.zm.��c.1�
zo_ � zo_ � zo_
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�! !( S(//.�--- I �nry ��.�/� I � (� V�/ ��
Ne above a oregoing infortnation is W e and cortect arM that ihe applinn[ is a resident of IfWiara aM
propeMon applicationisfiled.
ard snee4 pry, slate, aretl LP ootle)
person (numberaritl sLee; dry, slale, aM LP code)