HomeMy WebLinkAboutMortgage_Linsday"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� Stafe Fortn C3709 (R71 / fi09)
ti / Resaibe0 by DeO��rd o1 Loml GwemmeM Frerce
ur
�STRUCTIONS:
b be filed in person or by mail with fhe CounryAUditor or Counry Recolder o/ the counry where the property is located. ��
Fiiing Dates: 7) Real Pmperty: Must file durirg the yrear fw which the deduction is sought.
2J Mobde / Manu/actured Homes rrot assessed as Real Properly Must file during the Iwefve (12J months �
6efore Maich 31 of eaGr year fhe deduction is sought.
See `everse side for additiunal instrtictions aM qualifications. n i a c.,.. ,..
Distrirj
pap�Yty as m
Recorder
31 CeSCripUm Remid number Page number �
-3o3-o�v. a��-o �8 3 zYa
age / ContraG inCebted(mss unpaid as ol Mortgage / ContraG'uMebteCness unpaitl as d Is Ne applimri the sde
i 1. airtem yePr tlate of appGcation legal w eWrtade anre(.�
9� � � ❑ Yes ❑ No
tl no. vAUt's his I her exatl share al interestt If owne0 wiM someone other Man spa�se. indimte wiih whdn
It �ume m remd is d�Rerent ihan that ol appficani, om0icate Delaw:
Name of mwtgagee or contrarl seUer ./J .
/�f' / .
U �J��
AdEress of rtnrtgagee or mntrap se�rs (n�m6ei ard sbeet
Name af asvgnee or oNer owner or holder ot mortgage
AdEress of assig�ree (m er arW slree4 ay, s/a(e, and ZIP
Oces epplicant axn pmperty in eny oNer I(
�^p'�^i^em^aa n .,__ n .,_
2a I zo
I I We certi(y urMer the penaly of
owner I contracl buyer of the afon
�,�[" Sigrawre�(/g'ry/�/�,s_ fi�vreme)
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ardZlPcade)
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Is Cre pmperty in Questbn: MnuaOy Asses.-,e0
❑ Real ProPeKY ❑ ��Y �
Modle Fimre IIC 6
�i T
Goc��..�, sr�►�+u�c,N �
T��o, � � -�aua
couNn nunrtoR
zo zo _ zo
zo � zo _ -
-`� // I Counry I Date (rtmth. daY. Wa�
that Ihe a rW foregoing intormation is We and correct a�M that Ne applitan[ is a resident of Irdfana and
{�ed pmpe nn date application is filed.
� . Date (mrnth. daY Yaa/)
ss of a�nl (number antl sheet, rily, state� LP ar
) /�anl�� 1-% f�r�'nr;
eyd�eyexea,ced�annor�roiMi �i.i.iz-0.�
td person (numberaM snee4 �: sbte, and LPCOde)
o� (rr�un. dey, rea.�