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'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 hi Year
_, FOR DEDUCTION FROM ASSESSED VALUATION
� • Sfata Fortn C3709 (R71 / fi09)
�,.,. Presrribad by DepartrtieM af Laral Govemment Firence �
wsrnucnoNS:
JUL 1F11e �U
To be ned in person or by mad with the CountyAWitor or Counry Recorder ol the counry where Ihe property is located. F� ��:
FiBrg Dates: 1) Real Properfy: Must file dunng the yrea� /or whirh the deduction is soughL �� �nry AuditOr
2) Mo6ile /Manu/actured Homes not assessed as Real Pmperty: Must file dunng the tweHe (12) months n�
6efore March 31 o/each year the deduction is saqht.
GIBSON UN�'� A ��er
See reverse side Io�ddifional instructions arM qualifications.
I rapie �f � p�aprny aa of
w'ent ypar
ro.
L.�u.�
or nnrtgage, «crno-arl sene,
Pddres ot rtcngs9� u cantrad
Name at assignee w oNU awner
���� o �=� $ - c�l-Oc�.
ge/ ContraG inOeCtedneu unpaid as d h
Ma 7. airtem year d
u�E'vsie Eeb�w^
rAy. stete, aM LP mde)
i(number aM atraeL my, sbte, en0 Z/P code)
7�7e'nY in anY olher I/ yes. what munp?
���[�.���.r•
S�—O I q I Re�mtl numh� I Page
ia�/ CanSa1 inCe6tedness un0aid az d b Ne ePP�
G'�u."17
`�� � l./LJ I ❑ Yes ❑ No
wrneona other In sC�+x. hWicate witli MRnm
is Ihe DroO�Y in 0uestiav MnuaOyASSessetl
❑ Fieal a'overtv ❑ nrmua�N assessed
n+osae r�me nc ��.�-�
What Tadfg DabiU7 I���r Eeen ^uestr� on Wnpr+ty