HomeMy WebLinkAboutMortgage_Collins (5)' °"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 7ownship vear
FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Form 43709 (R70 /11-08)
` � Presaibed by Department d Lopl GwernmeM Firen�
INSTRUCnONS: Fle Ma
To be fded in persm a 6y mad witl� the CdartyAuditar d the covnty where Ne poperty is fxated.
Filing Dates: 1J Real Prope/ty: Must 7de d�uing fhe year Ior wh6rh fhe Geduction is sought JUL 2 0 2009
2) Mo6de / Manulactured Hwrias nd assesse0 as Real Property: Must fde tluring tlie hveNe (12J mmfhs be/ae March 310/ each year
the deduction is sought � �
See revarse sde lor a0ditional insWdions end qualificaGOns ��
�ao�m(o.Y,erorcn�nac��-s� o"`��%/ ` 6����TV AUDir�
��a����
Maml� 7. aueaM yea
tl ro, what ia his / her exad shara d iNeres�7
D- a.3- 600. /od- Gb?�' ra'O+
�/ Cmtad rtdaMedress unpai0 as N MoM1pape / CoMracl inAqMetlness unpaid as
wrteM year dala of appfimtion /�
m remtl is d�naaN Nan Ihat of xOD�M. iMimb bebw^
U amed with someo�re aher Uun sPase. 'ud'kate wilh rfian
��., w �...gay� a .uau, �. .
��� " -'
/iddIB55 d(Mf1edQBB Of M1:f8C� 5B�8f �RIR1�f,'f dI1.� i Ch'. Sfdie. d/M/ � C�p�
D����;���.jo.:a.o.�9....... '�>
��,-� .�o. ...3a�.5.......� z.�
�y�� ��. �� —
Dedutlion eCV�wea .� o�e =...,,.__ _.
COUNTY AUDITOR
2q � 20 _ � 2(1 _ � 20 _
counry
'a
v� u No
k Ne propary in pue5ion: MnwOy Asse55eE
� Real Pfopefty ❑ Annually ASSE5500
Mohile Hmrie (IC fi
20 � 20 _
�Y. Y�A
on P�M
20
I/ We certify untla [he penalty af perpiry ihat ihe above and Megang mfarmation is We afW cwrecl and that the appliwnt is a resident of Inda� and
owner I contract buyer of ihe a(orementioned property on Aate aDVlication is filed.
7natare�(owrefs (W narrHm� � Date (monrh. daY.1Ta�
F W residenl address of
� .50� S _
azetvheE Power of Albmey or by
��
aM21P )
� � e�r� Z"t.� �7 6� �