HomeMy WebLinkAboutMortgage_Delong"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS co vear
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 037W (R11 / 6-09)
S,«. S Resvibed hy DeP�rR of Larai Govemmenl Fnance 1,
INSTRUC710NS: 'Y'AR ��
To be fiied in person of by mail wifh Ihe CowtyAuditor or County ReCONer o( Ihe county where Ihe pmperty is located. F� �� �:
Fif Dates: 1 Real Pro Must file dun fhe C' '
mg ) perty: m,7 yrear /or which the deduction is soughf. ty Auditnr
2) Mobile / Manulactured Homes not assessed as Real Property Must file dunng tfie twelve (12) months ❑
6etora March 37 o(each yearthe deductan is saghG GIBSON OUN7Y Remder
See reversa side (or adUiLOnal instruclions and qualfications.
7. amni year
what a his / her eraft share of infrJest?
It riame m remid is d.Rerent Nan
��
C� legal desaiPtio^
'� �'�� �
Mortpage / Contraa hiM
March 7, arteni yee�
l 1i7�
, u�dimte bebvr
contrap seLer (mmihei and stree; cdy, s�.e. and LP oode)
of assignee w othu awner m halder M nqriyage
(numberantlatreet, rdy, s/ate, andLPcatle)
yes. vihat
�
i as N Mongage / CmvaU mde6tNness unpaN m d Is the epp�xani the mk
date ol eppfifation kgal or equdade wrtwlt
' �es ❑ No
If owneA witA someo�re other �han spouse. IMkate Wih wlqm
_'__"'__ _" _ _'._ _.:r.�_an.u�Mv Ac�^e�M
pE. �o�G, w Rs a
ao��- �vv
�'�.3, 75� `�'
�
� v�r
COUNTYAUDROR
Deductim approved 4i tln amount aF.
20 _ 20 _ 20 _ 20 20 _ 20 _ 20 _
Signahrte W Counb Auditur Counb Deb (ma+W. tlaY. Y��
1 I We certi(y under the penalry of perjury that the above arW foregoing infortnatlon is We and cortect and that the applinnt is a resident of trWWiana aM
owner I mntract buyer of the aforementioned property on date application is filed. � -
(o�meh Ld name) Date (mWA EaY. Y��)
3- O- Il
' en[ aEtlress of a t(numbe�and sbee4 �#Y, sbte, P wtle)
�D i
Person auttnrirEd Dy tluty exeated Power o(AttaneY a M IC 61.1-12-0.7 Da�e (manlb, dzY Y��
Pddress of auMOr'ved per'.�on (number aM sbeef, �y, sbte, antl ZlPmtle) .