HomeMy WebLinkAboutMortgage_Ellis"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 43709 (Rtt / 6-09) . _ � �
��w Presmbe0 M�� d Lod Go�emmertl Finarra �
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INSTRUCTIONS: q��qth.
To 6e filed in person or by mail with the CountyAUditor w Counry RecoNer of the county whem the poperty is bpted: ^ F� � U 1 u
FiNrg Dates: 1J Real Pmperty: Must file durirg the yrear lor which the deduc7ion is wught �''� J�� ��ry q�d�
2) Mo6ile / Manufactured Homes not assessed as Real Prt�perty: Must fiie dunng tha AveHe [12) monfhs i'�
6efore March 37 o/each y�ar Me deduclion is soughi. .R..i� �^tY Rewrdu
�'%4�. .63f.�^
See reverse ' e lo dditionel insVVClions and Quali�c�tiar�s.
npplxam�( r_ seerestricb'oacmr� ,. /� �,. .. . n GIBSON C �••••
aesa;ption
Avased ralue d real O�PeRY as of M�
A/mrh 1, a+m1c yqr Ma`di 7�, �
n �o. � �s ns i ng ��,ar� or w�a
tt rwre m'ecwE'n SRrmn tlan tl�az W aPP�. trMkate
Name at rtrrtgagee a mntrarl seeer �
Add�ass d rtnr[pagee a mntrecT srder (munber aM saeeG �l:
Name ol atsignee a other owner rn hdder of �age
AEaress of assignee (num0er a+M svee4 �: �, aM LP cod
Doev eppi�m wn wo7�Y in arry oNer R yes. w
Detlurdon app�orad In Ne amauN al:
2b
� IIWBc
owner I
�-t� • bS7' oc7.B a�a �, eb P�aa �j lc �
u�Pab as O( MMga9e / Contr3tt'vMeMedness �m7� as d Is Ihe eP� tlx Sde
date of aPP� � a��e a`T�
�O ❑ Yes ❑ No
rc a.,,�e wm, �,mm we. m� wa�. sw�e wm, �
�s me wov�r � a�: a,m,aey w�e
❑ Real ProPeAY Q'4rmuallY 0.�sed
MobBe Hortie OC 61.1=�
LP code)
COUNTYAUDRI
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Card \'O. ...;���....
� IvO, 50�, c� ...
gh
20 = 20 _ 20 _ 20 20 _ 20 _
tor Caunry Date (rtpnfi. EaY• Y��i
the alry of peryury the ahove and foregoing intwmation is true and corte�i and that the applipnt is a resident ot Indaria arcf
yer of e aforeme ' P�PertY on date apdication is filed.
ime) Date (rtwKh. OeY. Y��)
�� An , c�-�-,�
C apfiCanE(NMfbera sf�et, sfate.aMLPaotle) n
va7 . s���P si rr��
autl�tt� M ez� Wwm� o�,�anaY or M �C �,.,-,Z-0.,
i N autl�a'ved person (number aM sbeef, ary, sfafe, an0 LP mde)
�,� ���G7�
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