HomeMy WebLinkAboutMortgage_Cox (23)U
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
�_,. FOR DEDUCTION FROM ASSESSED VALUATION
• Stace Fortn 43709 (R71 / 6-09)
�' / pr¢svib¢d by DeparbneM of Laml Govemment Fi�nce
�srnucnoNS: �p�yfitt��)pddd
To 6e filed in person w by mail with the CountyAUdROr or County Recorder o! fhe wunty where the property is located. (J �y /�0 � 2
Fding Dates: 1) Real Property: Must file during the yearlor which the deduction is sought. � Counry Audimr
2) Mobde / Manufactured Homes rrot assessed as Real Prtiperty Mus! file dunng the fweNe (12) monfhs � Y`
before March 31 of each year the deducfion is saght. Recorder
�
See reverse side for adtlitional insUuctions arM qualilwfions.
npq'x.y�t (ownerormntract buyer - see rcxfic+iurts m reverse side) ^ �,
Ta�u� isfirt • K�� � D�'°°" - Y o o- v d 3 � S- D/ `J Record numher Page numDer
r
vahre d real a d Morigage / Conbact iMebtedness unpaid as of Mortgage I Contrac2 mdebtedness unpaW as of Is Ne appfrant the sole
Marm 1. pyrent yrar Mart�h t, curtent year Oate ot apW�� legal w equitade o�meN
�8I DOl� ❑ Y� ❑ No
It ro. what fs his / her e� shafe of intemstt 1/ ovmed wiN someone oNer Cun spouse, indimte with ��Rwm
If name on rew�d'a NRerent than Nat o/ apptiran4 m0ipte below. Is the property in puestion: Mnually Assessetl
❑ Rea� aoPeM ❑ P,�rmualNAssessed _ . _
IJame of mortpa9ee or mnvact se
'ddress of rtwrtgagee or contract
sbeef, ciry, slate, arrd Z/P code)
Name of assi9nee w athrr owner or holder of mwtgage
ACdress f assignee (number aM stree4 �+N. ��e, and ZIP a
� �
Does applirant ovm pmperty in any ofher If yes,
counryinlndena? � �,� � No
�
amount aE
20 _ I 20 _ I
�����ri�� _
T•
I! We cert"rfy uMer fhe penalty f peryury that
owner / mntracl buyes of the aforementioned
�
�
Persm auUro`aed �y duty exe�v�d
Pddress of aWmr¢e� persm (num
s
20
riry, state.
What Taarg Distric
COUNTVAUDROR
20 20
e arM (oregoing infortnation is true and mrteci
on date application is filed.
tlry, sble, an0 ZIP code)
�N �r�r� �o
dedudion
,� yean
on piopefty
❑ No
__. _ _ _
Drawer NO.. ���........
C�rd NO. .::.°.?�..I.>.......
1 �1, goa� ��
„-�