HomeMy WebLinkAboutMortgage_Loveless (5)^�� STATEMENT OF MORTGAGE OR CONTRACT INDF
s_, , FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 93709IR11 / 6-09)
�' �.r Presm�Ged q' OePanmaM af L�1 GovemmeM Fvance
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To 6e filed in rson w b maii with the Coun Audifw or Coun RecoNer of the coun where the !o F� p� �� �
Pe Y b �Y �Y P PertY is bcated. �,__.
Fitirg Dates: 7) Real Pmperty: Must file durirg the yrear lor which the deduction is soughG ` s�j • C��ni�'y qud"rtor
2J Afabde / Manufactured Homes not essessed as Real Property: Must fi!e durirg the fwelve (12) rtanfhs ,�� a,� e"��!�..,
6efae Mamh 37 o/each year the deduclion is sayht. D�BS� CWJ` � LL��xY'*��e�
See reverse side lor addilional insVUCGOns aM qual�catbns. .
AoMaant (owner ar confract burer - aee resbictions m rererse sidel /
T � Keyrwmber/�gal0esaiD� Recofd C
r��ut".e,� a� �l -0���03-00�. 6s �-v�8 O ,
AeesseA ralue c( 2al P'WeRY as d Abryag e/ Contraa irde6ted�ress unpaid as af Mortgage / Contraa mCebtedrress un0� as d
MaCi t. amnt year Merd� t. n�rtvrt�ear tlate of aPP��+
H m, what Is Itis I her �ct share of intrJest? '
tt rwr�e m remtl'a QAtumt Nan that o( aGP��t'mEirate Eeb.r.
Name oi ee a mntrarl se9er
�iv-t�t•e �' e_e�Gt�e F G (-1
Address d mortga9ee or mnva s�er (num6er and strae; ciry. state, aM ZIP code)
Name of asi�ee w dher awner or ImlCer of rti�rtgaga
PLdress o7 assignce (numbe� aM streeC c�rtY. state.
P�PQnY
H owned wiM someo�re oNer than spouse.
� Page rwmbu
S�
ls Ne aC7�� tM sde
legal a eQUitade ownen
n Yes ❑ No
15 propeRy in 7uestion: Mmu
Reel PtoPertY Q Mnual
lAoble
C� �. p�iC- b�
Has ihis deduGion been re9uestetl m P�openY
(Or WrtE(rt YeaR il .._ _ I-1