HomeMy WebLinkAboutMortgage_Flaherty"'� STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip
__ . FOR DEDUCTION FROM ASSESSED VALUATION
' ' smee w� aa�os cR„ i sos> l
� / Presaibed M DePart^ieN of Lod GovemmeN Fuarce p�
INSTRUCnONS: �I �' ` �
Fwm Nad with:
b be filed in person or by mad with fhe Counry Auditw or Counry Recorder of the counry where the propeM is located.
FiNrg Dates: 1) Real Property: Must file durirn� the ysar (or which Ne deduction is sought CoupN rtpr
2) Mo6de /Manufactu2d hbmes rat assessed as Real Prt�perfy Mus! file dunng fhe tweNe (12) monMs .�� �
befae March 31 0/ each year the deduction is sought ^ry �
al
See reverse side for addiUOna/ inst/uctfons and qualificatpns_
AppGp�t(owne�ormnvaC6uyms'�e res�rcy�s mreverseside)
Y / e l.�/ �/. //_ . i
Ta ' Distria `
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As�sed Yapie of ioD�Y as of
f1. ¢rrelrt
nm.�i�n�,wa�asn�o��
n rwne u, reme is amermt Nan ma�
Name W rtaryagee a contract se0er
Key rcmber / legel desaiGtian Recortf (wmba Pa9e numbrl
_o _ _�oo-000.3a9-o�7 aoip ioay
A1ort�age/ Cantract irdebteCness unpaid es d Mongaga I ConYa�2 inCebtedness unpaitl as d Is ihe appOranf Ne sde
Mart�h 1, wrtent year date d appfrcatim Iegal a epuitade awne(1
i3 33 ❑�� ❑No
tarest? rc owned wiN wnea�a nOmr than spouse. udimte wtth whom
triEkam Gebv`
Pddress of mort9a9e� m m�trap sr�er (num6ei antl streel �Y. .�ate.
Name of assignea w oCmi ownet or halder af mvtgs9e
aearess ot assignee (nwn6ar ane srteet �: smte. arie z�P ooee)
De0uc5on aPPrrn'ed In Me
�
any dher
Yes ❑ No
p_
\s 1
k Ihe. P�O�Y in 0��� MnuaM Assessed
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U yes. what county7 ��T 1//�iy� /� 1_ �
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�����,ry,��, � �3�, �33 �°i
I/ We certify under the penaf f perjury that Ne bove aM foregc.i _, . �
owner I contracl buyer of ihe afoiementioned p rty on date appii,:a��.,
Sq ra(ou.�ers/�rmr9e) � -- ' -
�/4
� (i
FWI resitlen[ aEdfes ol appGranl (number antl shee4 �; �le, a�q.�P mtle)
7 OZ1a E Soa /U /'� f-� lr� ii�i �l 7 666
Person autlw�d Cy Mdy executed Power of AOVney u Oy IC 6t.1-t2�.7 �� (��h. tlaY• 3��
prJSm (numbaraM sbeet �: sbte.