HomeMy WebLinkAboutMortgage_Dilger (2)r^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
: FOR DEDUCTION FROM ASSESSED VALUATION
� $tale Form 037091R71 / fi09)
�` pr¢soibeE by DepartmeN al Loral Gorernment Fi(w�ce
INSTRUCTIONS: �
To be lled in person w by mail with the CounryAudiror or Counry Recorder of fhe county where the property is bca�
Filmg Dates: i) Real PmpeRy: Must file dumg the year for which Ihe deduc(ion is sought.
2) Mo6ile / Manufactured Homes lwt assessed as Real Property: Must fife dunng the fweNe (12J months S
6efore March 31 0/ each year Ihe deduction is sought.
See reverse side Ior atlditional instruclions and qualfications. C
Mofxapt (owner a oonuad buyer- see reshirL'orys m reverse sidel . _ .
�.�.�r-/ 02�0- �-a'-'ia - 300-
d vapx d real popMY as af Mortgage / Contraa 4de6teOnev
1. ¢rrenl ytar Ma2h 1. wrtent ye�fr
n�.���sns�n���ar��n
If fume m �emN is Niferent Nan Ihat ot appGcant, us7icate below.
Name oi nqrtgagee or mntraG seller
.e-� �.�d
Address of martgagee w contrad seAer (num6er aM street ciry, sfate, aM
Addmssofassi9�ee� street,ctiY.
i� � [e.�.7�
e�'��.
Dces epplitant pm property in any oNer
counrym�MOna? ❑ Yes �
DeduGtion appw¢d In tl�e amouni ot
zo zo
Sig�aWre pN Cou�ry AuEimr
I/ W certify under the penalry of
owner / contract buyer of Ne afw
1 Sig�ture(ownershN+mme)"
X �;�,. x . n�,�
Year
,C(�ou9nTy Auditor
� @�Fmry Recwder
/ Recard num0er Page nurt�bes
�a.3�3 _ oa. oi 7�7
i az W Mwigage / Convact uqebceCrwss �mpaid as d Is Ne aPP�� ihe sde
date of appG�lion Mgal w epuitade owne/?
a ��l a ❑ Y� ❑ r,o
rc ownea wim mmeone wnnJ tldn spouse. udkate wMh whom
�s a�e wuvenv m a�es�,: a,nuaor,��:,�a
❑ Real Rvpeny ❑ Armuaily Pssessed
hhdle Hrnie (IC 61.1-�
COUNTYAUDROR
zo zo _
caun�j
the ve anE foregoing intortnadon i
pro rry on date applicalion is filed.
ary, slate, arM LP ootle)
MCress of aWwf'ved person (numbe�antl street, cay, state.
.u�� �ff"i�Z /q /, � �o fF
D'strirl? Has ihis deduCim Eeen requesteA m proprJty
for armnt yeY.+ ❑ Y� ❑ N
DI a titi•er' i\'O.. ,��� �
Cat v l��Q• ...,P I I /.... ..
�I�4,15L`L;.L� .......
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