HomeMy WebLinkAboutMortgage_Miller (36)^'* STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
__ s FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fwm 43709 (R11 / 609)
�' t Presaibed by Departmenl ol Loml Govemrtrent Flrerxa
wsrRUCnoNS:
To 6e filed in person or by mail wiN Ure CounryAuditor or Counry Remrder of the counry where the Fwope
Filing Dates: 7) Real Pmpefty: Must fJe dunng the year7or which the deduc0on is wught.
2J Mobde / ManulaUured Homes rwt asse,ssed as Real Property: Musf Ae dunng fhe lweMe
befae March 31 0/ each year Ne deduction is srought.
See reverse side for additron� instructbns and qual�catmns.
AppGq411�(owxr wca^tr�jt b ' 3ea rcs4q�tolc W wre�e side) N n A n
oistria
ra4ie of real
u�r1rt yrar
fi�TTl
Name of moriqagea w contraG seller
az
Addr�s d rtnrtgagrP or mntraa se0er (numba� and stree; cily, stam, anE LP cotle) V
Name W assignee or othu owner or holder d mortgage . -
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Doeseppliramv.mWOP�Yinany� DIa�VC'I��i�...�O..l.:.....
cowYyinlMgna? .
❑ Yes
oea�ao� evwoved in Cre ama,�� �
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Card NO. ....J...7-t �,,,,, —
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Coun Township Year
File Mark
F ed '
ifyi t
n ditor
(1 mon s
❑ Counry Recorder
AUG
iilade o�mM
Yes ❑ No
w:tt� whom
Is the property in puestion: MnuaAy Asxrssed
❑ Real Pfoperty ❑ ArmuallyAssessed
�,� ��
�� ❑ No
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I/ We certify under ihe penalty of perjury Mat the above and foregoing information is We and cortect arw
owner / mntracl buyer of ihe afo2meMioned property on date appfica0on is filed.
uaDUe(oMIe6hOnamel ♦ . . _• \ 1 _ /
ro«er d anon,ey
Address ot a Wiwrsed person (number aM svee4 tay. s1a1e.
61.142-0]
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