HomeMy WebLinkAboutMortgage_Caskey (3)^'�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wns r
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• FOR DEDUCTION FROM ASSESSED VALUATION
• Sfata Fortn 41709 (R71 / 6-W)
•S ,,,, , PreSa�beE 6y DeP�eN a( Lod Govemment Fitwxe
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INSTRUC770NS:
To be fited in person w by mail wdh the CounryAUdi[o� or County Reco�der o/ fhe county where the pmperty is located. ��
Fdilg Dates: 1) Real Properly: Must file dunm� the }rear for which tha deducfion is soughL � d��
2) Mo6r7e / Manufactumd Homes irot assessed es Real Pioperty. Must Re during the hveNe (f 2J monfh ,�,�1
6efae March 31 of each year the deduction is sought. - �IBB N yy� NR��I �
See reverse�ide (or addtional instrucUons arM qualificat"rons.
ryopsty as a
i - � v_�JU(J—U!J/.Q.7U0—(
Martgage/ Contract Intlebte0ness unpaid as of Murigage / C<
Martl� 1. curtent yrar date ot aPP�
11 n0, vfia15 ttis ! hu eYaG stiare oi intere5l7 If owned wiN SOmeane
Ii name an remd is ddlemrt Nan ihat of appGCant,
Name m mongagee «m,o-arl
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ciry, slate. andZlPmde)
Name al assignee a oNer ownet or twlder of rtprtgage �
Adtlress af assignee (number arM stree; rity, sbte, end IP a
Does ePplimnt oxn property in any other If yes,
counry in IMaria?
❑ Yes ❑ No
20 _ I 20 _ I 20 _
I/ We certify uMer Ne penalty of perjury that the abo�
oxmer I contract buyer of the aforemerrtimed propert7
I� :, e�
� Fup resitleni dres of a (num6er �
� �aa s �b� � va
Pelson auNOraetl by dWy executed Power
Address ot auNOraeE person (number an<
state,
1L NC,(J / oJ ' �f -
;yl NTat Ta�g �¢bict7
COUNTYAUDROR
�
Yes L1 No
perry in quesGOn: Mnually AssesseE
RoPertY ❑ Mnually `A,sessed
Has �hs deduCion Eeen 2questeE m p�operry
for artem Y�n r� .. r-� .
�_�� 20- � �-
llra�rcr �\'0... �
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Cal'C� 1�r0. ...,! lDJ �.......
`�97, a.g�. (,O .
city, sfafe, end LP cotle)
IDatn (nrmN. daY• Yea�
e applinnt is a resident of IrMpna and
Date (monfh, daY.
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