HomeMy WebLinkAboutMortgage_Brown"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
. � State Fwm a3709 (R71 / 6-09)
�' � PresaiCeC by DeparbrierH af Ldal Gm�emment F�nce
�� File
�sTRUCnoNS OCT fl��
!o be filed in person w by mail wifh the CounryAuditor or Counry Recorder ot the counry where the property is located.
Fdirg Dates: i) Real Property: Must file durirg the }rear /w which the deduction is soughG � quditn�
2) Mo6�7e /Manufactured Homes rrot assessed as Real Property Must fife dunng the fwefve (72) months C' ry g�mrd
before March 37 0/ each year the deduction is soeght. UDI uK �
See reverse siee for additional instmctions and qualifications. G�gSON
Appfv�a�t (ownerarcmtrdC b✓Yer- see �Ow�s m reverse side) .
�������
i1.armntyrar
If no. what k his / her exaU sliare ot inten
If name on remd "s tliReren� Nan Nat of �
Name a� mxtgagee ot mntratY seUer
Address of rrortgagee or wntract seDer (�
Name N assignee or other owner or holdi
Adtlressol � ee(numOernaMStree4
,/i � .Yi�
Dces eOW�� � MoCenY � any other
caunry in IMara?
❑ Yes
20 _ i �o
���
r I legal descipUm
-/a- 7-l01 - 000. a�3-,
Mortgage / ContraG intlebteOness unpaid as of Mortgage / Crnvai
Mamh 7, arteM yrar date of appfxation
8 I Reco'/.� � I I Page numbel
u�
If avmed with mmeo(re aher Ihan spouse, iMirate wBh whom
s/3
im6a� aM sheel, cey, sfate, aM LP code)
' d martgage
vy. slete. ard Z/P catle)/
If yes. what munry? What
❑ No
COUNTYAUDROR
zo _ zo
cou�ry
Yes LI No
I5 ihe p�operty in puestion: Mnually Assessed
❑ R� a.o�ny ❑ n�,�,uanyassessed
DI'1\1'CI" 1i�G�la.J.�4.........
Card NO. ....r.�.�l.........
����L`Q.(�
Date (manN. tlaY. Y��
I/ We certify urWer the penalry of pe�ury thai the above antl foregning infwmalion is W e and correct arnf that the applirant is a resident of I�iara aM
ovmer I mntrad buyer of ihe afwementioneA property on date applicatlon is filed. �
�^anye (owne(S1WDe+44!7 � Oate (/mW. daY. Year)
Pelson auNO�.M Ey
�/ ///C
r or by IC 61.742-0J
Address af autha'ved peeson (number aiM sbeeL �Y. sbte, and ZIP code)