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'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ _� FOR DEDUCTION FROM ASSESSED VALUATION ��
�• Sta[e Fwm 93709 (R71 / 6O9)
S,,,, 1 PresaibeE by Department of Ldal Govemment Fnarce
File Mark
INSTRUCTIONS: rr n n.n
To be filed in Y b �Y �Y P�PertY is located. 'PBrm N u�
person w b mail wdh the Coun Auditw or Coun Recorder of [he coun where the
Fdirg Dates: 1) Real Property: Must file durrrg the year for which Ne deduction is soughG =.��,Y,('qunty Auditw
2) Mobile / Manufactuied Homes rrot assessed as Real PmpeRy Must file dunng the hvelve (12) months !\ �
befom March 31 of each year the deduction is sougAt. ❑ Coun VRecarder
SeereversesideforadditionalinstrucUonsandqualilcafions. `'�BS ������•� �����vrc
MO��� (9'�ABiPr confrdst buyzr- ue 2s�irbwts m revarse�e�dei n .. .. �/ /% 7 � � .
wssessea �.�ue d re� a�a�r es or
Mamh 1, arm� ye3r
it m. what is his / her exact share ot interest?
-ii-�i-- uu-UU u�-
ge/ Conbact indeMedn�ss unpaid as of MMgage I Ca
Ma 1, wrreM year date of a f�
//o, B�
If owned wiM someone c
It name on reoord a ddferenl Nan that at appOCant, uMicate �ebw
Name M mMBa9ee or mntrarl se0er
Addres of mMga9ee or mntract se0er (num ri arM sG cdy, state,
NameofassigneewoMerownerorholderofmongage /
AEdress o1 assignee (number aM shee4 ctily, sfafe, aM Z/P co0e)
Does applicant own praperty in any oMer I tt yes.
munty in �Mana? r-i '_ r-i "
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W�at Taritg DStriU?
Is
RecoN numbel Page
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ar eduitaWe amM
❑ Yes ❑ No
perty in question: Mnualty AssesseE
�PQNY �Am1UaIlyA55essed
U�'s Ceduclim been re9urstetl m pmprny
urtentY�n r� .. r-i
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