HomeMy WebLinkAboutMortgage_Dill (7)^`+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wn ar
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FOR DEDUCTION FROM ASSESSED VALUATION
� State Fam 63709 (R71 / 6-09)
�' y,� � PrrsaibeE by DeG�nt M Loml Go+ernmeN Firence
File Mark
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�To be filed in person w 6y mail wifh the CounfyAuditor or Counry Recolder oI the county where Ihe property is located. n Co�
Fiing Dates: 1) Real Property: Must fJe during fhe year for which the tledudion is sought. �gS N Q�1 N 1 Y aU� �K
2) Mo6de /Manufectuied Homes rwt assessed as Real Prz�perty Mus! file durirg the twelve (12J rtwnth�
before Marc/r 37 af each year the deduction is sotght U �^h' Re��
See reverse side /or add'tional insVUClions and qualifications.
n t(owrrer orcontrdfl buyeksee resYA��s � reverse stle)
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/ her ewU share ot intelest?
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MartpagelContraaintlebtetl�ssunpaidaN Ma
March 1. a�rtent yesr AaG
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If twre m remftl a Q�Httent Nan ihat W app6ranl, trMVate bebw:
Name ot nqrtgagee or mnVaU seller
Af�df¢SS W fI10f1[Jd9E2 Uf fMVdCl5E�2r (n�alldS7R¢i �1'. 9
Name af �" �nee or aher owner ar hdder of rtqrtgage
AdCress oi a�gnee (number arM streek �l: s+ate, anC Z/P ootle)
Dces epplirsnt wm property in any aMer
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20 _ � 20
Sigrianire
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numbr! � Page
impaitl as d I Is Me aVd��nt Ne mle
Q U legal or epufta6le owne(.+
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�erty in W�rn: Mnuag' PssesseE
'�veM ❑^�^ualN�
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�anrg Distritl? Has Na deductim Oeen re9uested on P�Y
I..,e� ro� w�m y�n r� .,_ _ n
couNrrnuortoR
20 20 20
Caunry
20 I 20
I/ We certify un0er �he penalry of perjury that Ne above and foregoing infortnaUon is We and cortect arM that the applinnt is a resident of IrMiara aM
owner I conVad buyer of lhe aforemenlioned pmperty on date appliptlon is filed.
Sig`awre (owne/s (W reme) �,..� � 6dte (montl�, GaY. Yaa�
ciry, state.
duty ezecuteE Power W Atlomey or by IC 61.1-12-0.7
Pdtlr� af authoraed Ve�^ (num6e� arM street �WY. stafe.
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