HomeMy WebLinkAboutMortgage_Meredith (2)�� � �
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ' Toyms
FOR DEDUCTION FROM ASSESSED VALUATION ❑
ti—.. `� SbteFOrmC37W(R77/6O9) UC�. J L��J
PresaibeC Gy Depariment of Local GavemrtreN Frunce
File Mark
INSTRUCTIONS —
h 6e filed in person w by mail wifh the CounryAuditor or Counry Recorder of fhe wunty where the properfy is located. F� �� .� N
Filirg Dates: 1) Real Property Mus7 �ile during the year for which tha deduction is soughL po� gt�p(7 ,
2) Mo6ile /Manufactured Homes rrot assessed as Real Pioperty Mus! fi!e dunng the twelve (12J months Gf. 3t� ,--�
befo/e March 37 of exh year the deduction is soughG Counry Recorder
See reverse side tor addifional instmctions arM qualificafions.
Aoolirarrt mmerarconLa2Dwar-5eeresLictiinsmteversevde). . A n_ I .
c� —/ �r -u i� �/ o(..l V oi�i� 7
Asetsed raWe oFreal yopeny es of Mo�q age / Conbact indebtedness unpaid az of Mwtgage / ConttaU'uWeMedrress �mpaiE az of Is Ne appfcant the sale
MBrti 1. anm[ yrer MerCh 1, artenl date ot avP�m� legal W eqUnade o.meY?
❑ Yes ❑ No
If no, what Ys tirs / her e�ct shara ol interest/ If awned wiN someona other Ihan spouse, iMicate witl� wtwm
Ii tWne on Rmtl a Wferent Nan Mat o( aDP��. �ipte Cepw: I Ne property in a�estqn: MnuaPy Asse55e0
� �PenY � ArmuaOyAsse55ed . . .
orcono-act
of rnortyagee w contrad se0er (number aM s1reeL �ry. sJJte, aAC Z/P cade)
rvame m assignee w omel wmer w twwer rn mortgage
naaress oi assgnrE �numcer an svee4 my. sem. am ur coae7
Does applimm ovm propeM1y in any oNer
iOUNTVAUOROR
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20_ � � � p— � 20— � p—
Counry
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(�a-sa8� �a
20 _
Dale (monN. daY.Y��
20 _
1/ We cerUty uMer tha penalry of perjury Nat the above and foregoing informatlon is We and cortect arW that the appli�ant is a resident of IrWiana arrcl
owner I contract buyer of the a(orementioned property on date application is fiied.
`SglnaNre wneYS hID Date (rtmfi, deY. YBa�)
7� f .
r,vn ms;ae appGwnt (number and sfreet dty, s7ate, aid ZIP ootle)
Ey tluty ezecutetl Power of Auwney or Oy IC 6L742-0.7
ACdress o( a Wiwtred person (numbe� aM sbee; riry. sfa(e.
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