HomeMy WebLinkAboutMortgage_Hurt (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year �
_ N : FOR DEDUCTION FROM ASSESSED VALUATION
• Slata Fwm A3709 (R11 / 6-09)
� I Presaibed by Departmenl of Local GovemmeM Fnance
� File Mark
INSTRUCTIONS: MAY
To 6e filed in person w 6y mail witM1 the CountyAuditor or Counry Recorder of the counry where fhe pmperty is focated.
Filing Dates: 1) Real PropeRy: Must �le dunng the year for which the deducfion is sought. C.`J. unty Audimr
2J Mobile / Manulactured Homes irot assessed as Real Property: Must ne dunng Me fwefve (12) months
before March 37 o(each yearthe deduction is sought. nty Recorder
See reverse side foradditional instructions and qualrfications. GIBSON C
AooGramJowrer oraontrarl buver- see 25InrAOns m reverse sidel _ . .
Ta OiSVttt ' Key number / legal tlesaiption Kp -- Reco�d numDer
i�.�,�m� a 6-/�- 0 7-�l o/- vo% S 3 0- o� 8
Atgessed vaNe oF real poperty as d Abrtgage I Contraa irNehtedness unpaid as W Mortgage / Contrxt iMebtedness unpaid as M is ihe
MaNi 1. amem ym Efa�tl� 1, wrrent year date ol eppG�tion 1eg21
wha� is his J M eracl share Of interest?
iume m fem�tl
Pildress of mort�a9ee w contratl seqfir (nurriber and streef, ciry, sta.e, ard ZIP oode)
Name of atsi��ee w ahu awner m twlder ot rt�ortgage
Aaaress ar astignce (number aM streeG cd
Cp-��
Oces appli�nt ovm properry in any aher
counrymlMena? ❑ Yes �
DeEuction approved'm Ne amount of.
20 20
sbte. antl ZIP Cotle)
� a8 PT
�f�.�„�����
No
COU
20 20
Page number
iBade oxirel.+
Yes ❑ No
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4UDROR � , a a! �00. �/
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I I We certify unAer N penalty of pe " Nat the a e nd (oregoing infortnaiion is We an�
owner I contracl buyer of the aforementioned prope n date applira ' is filed.
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f�A�`�° ent adOmss of appficanl (wmber arttl shce[, tiry, slate, antl ZIP ootl
`70cs -s � �°l1�Ji%L/'�/��/ � i'�t/C'[°%o/(.� ,
Pefson authoraed Oy dWy ezecuted Pw�er of AttomeY a q' IC 61. t-12�.7
P4d�ar at auNU'ved persa+ (numberaM sneef, dry; state. anC ZIP mde) .