HomeMy WebLinkAboutMortgage_Wirth (3)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T s p Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION '
Smte Fortn 93709 (Rtt / 6W )
�' y„ � Presaibe0 q DeVa�M of Laal Govemmem Fnance Q U�j leqI�p
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INSTRUCT70NS: F� �� �.
To be filed in person a by mai/ witA the CountyAuditor or Counry Recorder o( the counry where the property is located.
Fil"mg Dates: 1) Real Property: Must fife durirg the }rear Por which the deducfion is sought. •.+,�? nry Auditnr
2) Mo6i7e / Manufadured Nomes not assrsced es Real Property: Must file dudng the fwefve (12J monNs /J"n g�m,,f
6efae Maich 31 ofeach yenrthe ded�ction is sought GIBSON OUF�PY (J�i �
See reverse side !or additional instruUions and qualifications.
AvP6�j9� (owmr�prconaaC 6vyer ysee msMrboru m reverse side)
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rlame or assm� a ang awner a r
oi app6can; uMireoe beb�-
6mnt wm poperty in any oNer
�M"au? ❑ Yes
Dr�uCion aPPrwed'c� ihe amwnt af:
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❑ Yes ❑ No
rc oMrea wim sa�rre aNm tlun spouse. a�airata rin, whon,
k Ne WoD�Y in Vurstion: MnuaDY Asmv:d
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a�o� r� nc ��.�-
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If yes. what caunt�t Wlml Tadr . - Y
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couNrrnuoRaR
20 20 _
Sig�hire W Cac:ty� ^ /(
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I I We cerGfy under Me nalry W perjury
ow17�r I wntracY buyer of �he aforeme�c
p_ � 2p � 2p _ I 20 _ I 20
I Counry I Dete (montn, aar Y�n
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�the above aM toregoing infortnalion is We and corted antl Uiat tha applitant is a resident of Irwiana and
PmPertY on date aPWicaGon is filed.
. . \ / .. Date lnnndi. daY. Y��
oy a�er �euem aower or ammey or ey ic 6� �-i z-0:� — � I o�e (monN. dar• r�A
�ed perv�..on (num6er and sbee; tlry. sfate. and ZIP code) .