HomeMy WebLinkAboutMortgage_Wayman (3)Nn STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
: FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 03709 (R71 / 6-09)
� � Presaibed Gy DePartment of Laal GovertuneM Firwce
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INSTRUCTIONS:
To 6e filed in person w by mail with the Co�ntyAuditor or Counry RecoNer of the county wheie the property is located.
Fifing Dates: 7) Real Property: Must file durirg the }rear /or which Ne deductlon is sought.
2) Mo6r7e / Manufactured Homes rrot assesced as Real Pruperty Must Ae during the hvelve (12J rtanNs
betore March 37 of eacA year Ne deduction is sayht.
See reverse side foradd �ne��ions and qualifications.
�m(ow�roscm t-see�esL"ctionsmreyrrseside)
I vahre U real pmperty
armayar
f exaQ stia�e of Interest?
dAfuenl Nan Ih2i of appBtant, uditlte DEbw.
Nama W mort9a9ee or mntrarl seller
Adtlress of �mrtqagee n contrad seAer (nurti6ri and sCeeL �}: stafi.
Name of assignee or oNU owner w twlder af mMgage
P.ddren of asagnee (number aM atreef, rdy, stete, aM LP ootle).
Dces eppli�n[ avm properry in any oNer If yes, wh
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GIBSON
a
Yes ❑ No
someorie aner man spous9. uWKate wlm vmom
IS C12 P�GQrtY N QIICSfl011: MIILL30`f ASSCYfE
❑ Real ProPeKY ❑ ?��!�1! �
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s� m P�nY
Yes ❑ No
2� 20 _ 2(1 _ � • 2� _ 20 _
Sigrenne N Camb Auditw Caunry Date (rtqnM. daY. Y��)
I I We certify uMer ihe penalry of peryury that the above and (oregoing infortnation is W e and corre�Y and that the applit2nt is a msident of ItWiana aM
owner�/ contract buyer of ihe afaementioned property on date appliration is filed.
Si4na'ure (owne/s /ufl reme) „ 1 �� (�. �Y. Yae�)
p'rJS'w� author'vsd by Ouh/ exewted Pawer
Pddtess of auNw'ved person (number am
e4 �1: sbte, arid LP ep
T FTd���
neY � M IC 61.142-0)
tlty, state, end LP Cotle)
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