HomeMy WebLinkAboutMortgage_Anthis (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ � FOR DEDUCTION FROM ASSESSED VALUATION ,'
. . • State Fwm C3709 (R71 / 609)
S � Fresvitea M �evaRment or L.ocal covemment Fuunce
File Mark
INSTRUCTIONS: OC F
To be hled in person a by mail with fhe CountyAUditor w Counry Rewrder o/ fhe tounty whe2 Ihe properfy is located.
Filing Dates: if Real Property Mus[ file durirg the yrear (or which Ihe deduction is soughL County Auditw
2) Mo6ile / Manufactuled Homes rwt assessed as Real Property. Must fi/e dunng the IweHe (72) monfhs �?
6e(ore March 37 of eacA year Ne deduction is sought ��" � nty Recorder
See revers " e foraddifional instruclions and qualificafnons. GIBSON
Appfican or�pptraC buyer - see restictions m reverse s� y� . �. 1
. .a.. .,_ .... ..,. :._.... � .�._..�..__ .�_"_"__
a 300-000� ?��oao � a� � � �
vairo of mal papMy as d ^ MortgaBe I Cantract'ude6teEness unpaid as d Mortgage 1 Cortvarl'udehtedness unpaid az o! Is Ne appfirant ihe sole
h1erU t. aaiau Y� Mard� 1. rtent Y�� � date o( avP��� legal or eWi�aHe wme/?
❑ Yes ❑ No
If rq, what's his l her eraC Sl�are ol inteie5l? If awnetl wiM someane oiher than spousa. IMkate witli whom
tt name m remd a QMemn Nan that o( app0�ani, Indicate 6ebw. Is ihe property in QuesUm: Mnua%PSSessed
❑ Real Roperty ❑ ArmualyAssessed
MoWle Fbme OC 61.1-i
« mntaa
��!'�Li-r's-Y''�',_:t �
or othu ownet or hdder of rtqrtgage
s�
cdy, state, aM LP code)
AdEress ot assignee (nurt� and streef, cdy, stete. eM Z/P cade)
Does epplimm am proprny in arry oNer
counry in Inaona? ^ _ _
If yns. what munry? I Wl�al �ann
COUNTYAUDROR
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DCa\\'�1. �Q,,,,O,`.. .
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Card 1 �y� 15pp; �o
ction appmvea m ure amount ot
20 20 20 20 _ 20
Caunry
20 � 20
I/ We cerUfy under �he penalty o( perjury Ihat the above arM foregoing infwmatlon is true and mrted and that Ne appiinnt is a resident of Irdana and
owner I m buyer of the atorementloned property on date applicalion is filed.
� —•L'—���. / . '1 . / • �'^ _ � Date (mand�. daY.Y��)
cotle)
m b�IC G7.7-12-07
P4Cr� W aWiarsed person (numbe�aM sbee; ri(y, uate,
Date (menN. daY. Yea�i