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V
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fwm 43709 (R71 / 6-09)
,„„ Presaibetl by Departmen[ al Laml Govemmenl Fuianca
INSTRUCTIONS:
To be filed in person w by mail with !he CounryAuditor or Counry Recorder o/ fhe county whe2 the property is located.
FiNng Dates: 7) Real Property: Must file dunng fhe year (or which the deduction is mughf.
2) Mo6i(e / Manufactured Homes not assessed as Real Property: Must file dunng Ne tweNe (12J monfhs S E
6e/ore Ma�ch 31 of each year the deduction is sought.
See 2verse side /nr addifional instrucGons arM qualificafions. C.
Appfxant (owneror a auyer- s 7dons m reverse side)
Q � GIBSON
Ta�urg District Key number / kgal desaiption '. Rec
a - �- i3 -yo�t-000. � _va.6
J
Y�
2 �OQnuntyAuditor
IL
Counry Recorder
COUNTY
A�essetl �2hu dmai {aaperty as W Mor�qage / Contract 4dehteCnass unpaid as d Mortgage / Contraa udehtMriess �mCaid as d
Ma�tl� 1. amrmY� Martl� 1, wrmst year Aate of ap
n no..mai a na i n� �� ar �,�sn
If name m n.mtl is SMsenl Nan Wat of aPP��6 mEicate bebw
Name of nnrtgagee «mntract seller ^
��
Address of mort9agee w contract u�er (numher arM sbee; crty, stete, aM ZIP code)
Name al asslgnee w
wm p�operty in any other
�a? ❑ Yes
er ot mortgaga
dry, slafi, and
No
If yes. what muntyl
�1'�'S 9/�
someone ouce. ma� svo�se. i�aicate wm wh
Is the property in puestic
❑ Rea� arovenv ❑
VJtNt Taring D'atricl?
ritable awneR
Yes ❑ No
�
N's deduUion Ecen 20uesteC m 7�Y
urrent yea(.+ � _ _ �
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