Mortgage_Stiles""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
Slale Farm 43709 (R70 H 7-08)
� �� Presaibatl bY DapaM�ent d Loral GwemmeM Frtwr�
lNSTRUCTIONS: .�._O
To be filed in person w 6y med witl� fhe CaeNyAWdor d Mre counly where the propeRy is bcated.
ru� oa��: �� aaei a�,ry: M„� rua n�9 u�a y��ro. wr,�a, are aae�� u swyn�. .1 UL 1
2) Mobde / Marwladured Homes rrot assessed as Real PropeAy: Must fde dunng Hie tweNe (12) mmths befde Mardi 31 o���year
the deducYion is swght
See raverse sitle7oraddd"anal insWd'q,
naar�m� �.00m,�nwm-�,�a,
T � is ' Key n�
AssasmE v��e of real pWeM as of
IIAam,h 1, airtern yea
H ro. what is hu / �m ezad shara d irrterest7
a�a vuarfi�a«�:
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(vme m �ewd rs aiaerem �tu� that ot aooGam. u,a:am ce�o.l
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Name d assignea w oNx wnwr a halder d moM19a8a
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ST.T1.� S S� Pl.� E� C
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Signatura d CwMy Auditu
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GIBSON
Q I leqal or eQUdable awre(!
❑ Yes ❑ No
iM'rale with rlwn
Is Ihe pmperty � Oue9im: MnuaDy Assassed
�RealPraperty QMnualyAssessed
dedudion been rapuested on pmperry
M yeaf!
❑ Yes ❑ No
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I/ We cerlify unda the penalry o( perjury that the above and foregaing'v�formaU ��,�...a"
owner I mntract buyer of the atorementionetl property on Cate apptication is file0
FNI residenf aEEress af appGwnl (num6eraM sboot, cdy, sFale, andLPmJe)
�13o s. 4aa\\ Sz. Fc:��etn� S!J y-�bl�
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ann. aar. r�l
's a resiAent of Indara and
'N. OaY. Y��
o�e p�,un. ear. r�f