HomeMy WebLinkAboutMortgage_Miskell (6)"'� STATEMENT OF MORTGAGE OR CONTRACT IN ES C n Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATIO��
State Fortn d3709 (R71 / 6-09)
�' ,�,� � Presaihed by Department a1 L.aml GovemmeM Fnance p CT 3 �
File Mark
wsrRUCnoNS:
^ Form (li ed wlih:
To 6e filed in person or by mail wi(h the CounryAuditor or Counry Remrder o/ Ihe county wh�ie 71ie pro ' ted.
Filing Dates: 1) Real Pmperty: Must fJe during the year /or which the deducUon is sought. � Counry Auditor
2) Mo6de / ManufacNied Hanes rat assessed as Real Property Must file
before MarcA 37 of each year the dedudion is swghG GIB�� ���a�� ❑ Counry Recorder
See 2verse side fa addifional instrucGOns arM qual�cations.
Wo7ertY as
m.
`wmber / legal desaipUon
�— -� ' Z
Mwtgage / Canbat
Mamh 1, airtentye
tl fwrie on mmN s E'firlent Nan ihat ol appGmni, uWKate belwr.
Ndff1E Oi IMRfJd9E2 Of Cq1IIBCl SCOE
UN
aearess or morcqay� «�a,o-an s�
Name of assignee w other owner or
slaLB.
o( assignee (numberaM 5bee4 a1y. s�ate. and ZIP code)
ptiranl ovm property in any W�er If yes, whe
ilndFana?
❑ Yes ❑ No
rJ
Remrtf number
//
iitade awnerl
Yes ❑ No
If owned with someofre other than spouse. iMkate with whom
Is �he WoPenY in Ques4m: MnuaOy Av^eSSed
�2eal anaer+v ❑ ?,mn!aM nssessea
rnts it�c.c, �?ca Ee � �-
1 I-��a 8 oai3
VJhat Ta � Q�I �� ^ J_ � n',
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