HomeMy WebLinkAboutMortgage_Hurst"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATION
• .• State Fortn C3709 (R11 / 6-09)
�' � PresaibeA �y DepartmeM aflmal Govemmerq Firenca
� � � � � �
wsrRUCnoNS:
To be filed in person a by mail wifh the CounryAuditor or County Recorder of the county where the pioperty �s located.
Fitirg Dates: 7J Real Properry: Must file durirn� Me year Por which the deduction is so��{h � n O� O
2) Mo6ile / Manufedu2d Fbmes rat assessed as Real Pruperty.� Musf L�� the �eg 12 monfhs
befo�e March 37 o/each year the deduction is srought.
See reverse side 7or addifional instiuctbns and qualfications. C���
AppGmm (owner m r- /s�ae ' m re side ) � \ �
_ �/ J p(� (�(.I (�1 ON COUNTY AUDITOR
an
nz :i
GRterenf Vun that o/ aP�i. ud'vate 6ebvr
Name of rt�ortgagee ar rnnaact sMler
AOdrea d mortgagae v cmtrati seAer (nuMer and streef, rdy, s
rla,na m ass�ea or ang own« «naac m rtpri�a9a
Aeeress of assignee (numberend abeeL �: s+ate ie)
Does aPWipN wm P�PenY in any d`
���
I I Wt
owner .
/
/ �\.......
�;�� �� ; �,�a
�,, 3 .
�� ���'�� —
`O � �cA
c�t ��
q��g
.,iry of perjury t the above
. of the aforemerrtioned property on
Pssm autlo�'¢ed Ey
sneet aN.
1 �-OU
npaid es af N
—J
�.^r''
�
Year
Fiie Mark
Fortn t�ad with:
�}" CounryAuditnr
�� County Recorder
RemN numCU Page
O�/ / �
Yes Ll No
Is tl�e DroOe�Y in OueSCOn: AnnuaM A,sesse0
❑ Real P'oPeNY 0 ��Y�
Moh�e Fiart�e OC 6
munn? I Wtal Ta�dng DislriG? I Has Ni5 tletlutYion Eeen reques�eE on properiy
' tw arrent yeaR
❑ Yes ❑ No
GOUNTY AUDROR
�_ zo_ � �_
Caunry Date (nmM4 daY. Y�
,� -pd-/
a oing infortnatlon is We and cortec[ and that Me applirant is a resident of IrWiana ard
application is filed.
oate (�+M daY ��l
person (numDer and Sbeel, tiy, stafe, ard LP code)
Qate (monN, daY. Y��