HomeMy WebLinkAboutMortgage_Fogg'�� STATEMENT OF MORTGAGE OR CONTRACT INDE
_ + FOR DEDUCTION FROM ASSESSED VALUATION
' Slate Form 63709 (R11 / 609)
�' yu � Presmbed M DeP��M o( Loml Govemment Frmnce
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INSTRUCTIONS:
To be filed in person w by mail wiN the Counry Auditw or Counry Recortler o7lhe counry where the pmperty is located. � A
FiNng Dates: 1) Real P/operty: Must file dunrg the year /or which the deducUon is sought.
2J Mo6ile / ManWactured Homes rat assessed as Real Property: Mus! file dunng the tweNe (72) months
be(ore March 31 of each year Ne deduclion rs sought. ;�;
See reversa side (or adtlilional ins7rucGOns arM qualifications.
MPr��t (uwr�orconbav byym{' �_ m my�se e)
Auditor
Recorder
T' D�strir� - Key num r/ al d�aiption ' RetorE num Page num
-i a-b�- a-o co. S i S-o B �7 �a�
veEx d� qopeny as d hlonpage / Contraa indrbtedn�s unpaid az o( Mwtgage / ConraG rt�debtedr�s �mpxid as o( h Ihe app�ant the sde
btmd� 1, amnt year Mart�h 1, w yeer date of appGmtion lepal w eQUilade owrreR
"°'�a000 ❑ Y� ❑ No
If m. what is tds I trer e.ra�Y sliare of interesl? If wmed vriN someorre oNer than spouse. indirate wNh wlwm
It �wrie m remtl is Qdfemnt Nan Nat of app6cant, ind'uate beMr. ,I-s i,h�e pmperty in Quesbon: Mrn�aOy Assessed
L�3T��� �PenY ❑ Mnualy Assessed . . _.
IJame oi mongagea «mntrxt
AddressdnnrVjagrxw¢ — .` .•��•.•MZIPcode)�l,_
Name ot assignee a other � lG ii �v / �_ /J� ���
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o.Edressotassignee(num p1.7i1'C'1' 1�'Q..�pjy,lLl.,[..� .
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Dces a�imnt rnvn G�oP Ca i� 1� ��� O. V-'� / 1.
munty in InOena.
for
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Yes
P�nY
No
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