HomeMy WebLinkAboutMortgage_Minnis (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s Y
_, : FOR DEDUCTION FROM ASSESSED VALUATION
� �• Slate Form 43709 (R71 / 609)
S,� PresaibeE by DepartmeM ol Loral Govemmenl Fuance
F''�` 2 6 2012
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To be ned in person or by mail wiN the Counry Auditor or Counry Rernrder of the county where the property is located. ���;����
Fd'mg Da[es: i) Real Property Mus161e during the year Ior which fhe deduclion is sought. Q Counry Au Ror �
2) Mobde / Manufactured Homes not assessed as Real Pmperty Must file dunng the hvefve (72) monfhs n C➢unh V�
6efore March 31 o/each yearthe deducfion is sought. 185�3}J CUUNTY AUDITOR
See 2verse side !or edditiona/ insfructions and qualifications.
MP��L(9w�r➢rFO^tractbuyer-sep�resMUionsyr�eversesde) .
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property as ot Mortgage / Contraa irdebtedness unpaid as o( Moriga9e I Convar2 mtlebteMess �mpaid as W Is Ne eppOrant Ihe sok
MarM 1, current yrar date of apP���� �egal w equBade mme(.�
�� ❑ Yes ❑ No
e�ct share of inte.rest? If avmed wit� someone oNer than spouse. iMicate wah whom
fterent lhan that of appdcarLL, trd'uate 6ebw. Is property in O�+estion: MmuOy Assessed
Real RoPenY ❑ ���Y �
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rlame m morcgagee «mnaaa seuer
Address Of nm[gagee ar mntract seA
Name of
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ary. stete. antl ZIP code)
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Synature U CowN Auditor
COUNTYAUDROR
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Counry
Has N"s Cetludim Deen re9ues[ed an pioperty
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1 I We certify urWer ihe penalry of perjury thai the above aM foregoing infwmalion is true and correu arM that Me appiinnt is a resident o( IMiana aM
owner I contraG buyer of ihe aForementioned property on date application is filed.
17a4�re�p{s hdl fartre) Date (monfh. daY. Y��
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ao.�er antmmer � M
MdressotaWm"¢edpersm (numberarMSbee(dry.sbte.andLPOOde)
Date (monN. da):