HomeMy WebLinkAboutMortgage_Sisk (2)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fwm 43709 (R77 / 6-09)
�' ,.,. � HesrnDed by DepartmeM of Lorvl Govemment Fu�ance
INSTRUCTIONS:
To be filed in person w by mail with the CountyAuditor or Counry Recorder of Ne county where the property is located.
Fii"mg Dates: 7) Real Properry: M�st file during fhe year for which fhe deduclion is wught. J I
2J Mo6de / ManuFaUUred Homes nof assessed as Real Property Must file dunng the tweNe (12J months
6e(ore Maich 31 0( each ysar the deduction is sought.
See reverse side 7or atltlRional instrucGOns and qualifications. `'
'� (o roraontraU6uyer-see svir'aonsm rse e)
n.,� � „ � .•. � cissor,
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Assessed �2hie of real VoOe+b as W AbKqa9e / Contrars indrbtec
Ma�di 1. nnem ym Memh 7. arte`rt yeer
If ro� what is 1us / her rxaa share OI interest?
It nama m mmrE s tliRermt Nan Nat of appOran4 ��� bebv.'
Name ot rtnrtgagee or mntract seAer
� ot matgage
_ entl Z/P code)
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DeduW �/ � \ � v 1
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519ra�ure o ���
i � we ce� ��i\lN^'�
M.,,�e, i..
If yes. wh3t
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i as ot Mortgage I ConSaa'uWebtedness unpaid as of h Ne app6rant the sde
date o/ appGration c�i� legal �a reyquitade o�me(.�
��� ��i d U � � ➢G Yes ❑ No
tt ovmed wiih swneorre other than spouse, iMicate wfth whom
Is Ihe praperty in piu50on: MnuaOy Assessed
(�ealProPertY ❑?�!���Y� . , _
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Cal'd �0• .....................
Has iha deduction Eeen reGUesteE m property
For curtent yraf.� ❑ Yes ❑ No
20
Date
2�
_ ..,�wmaUOn is We and cortect aM Nat the appiinnt is a resident of IrWiar�a antl
r on date application is filed.
Date (monM, �ay, }�a� �
� 1�1�
Person authorrzetl __, uwer ofi A[torneY a M IC 61.1=12-0.7 � I Date (mon1/�, day, yEa�
Pddress ot authorrsed person (number aM stree(, dry, stare, aM LP wde) .