HomeMy WebLinkAboutMortgage_Carlson""'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Pam 43709 (R10 /11-08)
� � Rasaibad CY Oepaetrnent d Laral Gwemmertl Finanm
INSTRUCTIONS: i
w„°�Bo�s �°j`a PbropeAy MustfdedU 9i ��°�%��°rtyi,awa e�u a,��`ocated JUL 6 2009
2) Mo6de / Manufactured Homes not assessed as Real Pioperty: Must fde dunng tlie hveNa (12J manNs be7ae March 31 o/each yen�
the deduction is sought. `—y���
See revarse side for adddional insWClions and qualifications Q�(a ���
ApplicaM � e� or mnfrad byw- see rcsbid' �m mror� sde) � n � n _
�Y \\ GiaaeN ea NTy A�Gd�tdw
1, amenl yea
H ro, whal's his I her e� shara
6er/Iepalaewip5on �
- t a-1 g- an t-oa
Mor�aga / Lanirxy'sNebleMess unpaid as d
u mme an rewa is Qmarem lhan uia� ot aoo�m. u�dimm hebr.
Nartre ot mnigagee or selle
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r�e a assy�rea m an�, o�,� a
Pddrass d asyree (rwm6w ad shee( M: stab. and LP wde)
S
legal
number
❑ No
NI�II30111B011B W�IBf IIWI SGW'+0, YN�IWIB'MIII WFqfll�
— � — /� Iil55B$$B�
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ao��y �� �,y wnar � K y�. wa� mwr'+ � wn� r�rg o�sc;a?
Has Udv dedudion 6een�e,aqu�pesfed on pmperty
6ramerayean LJ Yes ❑ No
COUNTY AUDfTOR
Deduclion app(oved in Ne artwurit of:
20 20 20 20 _ 20 _ 20 _ 20 _
Signature d CwM' Audrtor Canry Data (maiN, daY. Y�)
I! We certify un0er the penalty o( perjury I�at fhe above anA fwegang mfwmation is We and careG anC that the applicant is a resident of Indare and
owner / mnGaq buyer of ihe aforementioned property on date application is filed.
SipnaWre ownersRanartre) pata (rtMnlh. day, yr,ar)
� u idenl address d applican (nvMer erd sbcet, uty, sb�. and Z/P wtle)
'� �0 �. �i✓Ce-
Person aulhortzeE by duy eReaited Power o( Albmey a by IC 6-7.7-72-0.7 Date (mon1A, day, year)
nderass or �nn�ae va� (numbrr and shco4 dty. sfate. aM LP oodo)