HomeMy WebLinkAboutMortgage_Frohbieter� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T ' Year
_ = FOR DEDUCTION FROM ASSESSED Vl1LUATION j
. . �• State Fam 43709 (R71 / 6-09) q
� � PresaiOeE by DeP��N of Imal GovemmeN Frence JL
� File Ma
INSTRUCTIONS: M �_
To be filed in person a by mail with the Counry Auditor or Counry Rernrtlei o/ the counry whe2 the property is located.
F�fig Dates: i) Real Proparty: Must file dunrg the year fw which the detluclion is sought � Audhnr
2) MobBe / Manulactured Homes rrot assessed as Real Properly: Must fiie during tAe twelve (72) maiMs
6etae Ma2h 31 o/each year Ne deduction is sotght Recorder
See rererse side foiadditional instructbns arMqualifications. GIBSON ..
Ap�r�(owneramv2Cbuyw'see mreve�ffie) . ' .
1, w'ent year
tt ro. wfiet Is h'a / hu e�r1 share of intercst?
- �- oo-ooi. 93a -� <
/ ContraG in0ebteEness unpaid as N Mongage / Con7aG
urtent year Caie of aDp�ion
�. .SOD
M narne m iecIXd a Nfterenl ttun that of appOpnf, hiGicace Eelrnr.
otmortgagee«cant(aGS�ller .
fify. StafB. eM
Name ot assignee w WMl ownet or halder af rtartgaga
Pddmss of assignee (numbar arM street �: �, � ZIP code) .
Ooes ePplifant ovm p(operty in any oNer
munryinlndana? !'l .,__
RemN numhel Page numbef
D /
�mGaiO a d Is Ne aPP�^t the
legal or equitatde mmel.+
❑ Yes ❑ No
If wmed wiih mmea� ofher Nan spouse. iMimte with Mwm
�
COUNTYAUUROR
Is the propeny in qunstipc Mnually Assessed
] RealFroaertr ❑ MnualNAssessed
d-�
Fias this deduction Deen requestrL m property
tor a�rent yeaR ❑ Yes ❑ No
Euctlon appmred in itre amounl ot �''�
20 _ 20 _ 20 20 �O!.N.. . • .. ••
DI':l\\'Cl' 1�"
pawre dCamryAUdimr Counry V _' � I LJ . . . . ... .
C.'ll�Ci �Q• ... l _�
I I We certify urWer fh penatty of perjury t the above and foregoing infortnation is t �
owner I contract buyer ot Ne aforementioned property on date appluaqon is fiied. �y��
�� �(a rY hd rartre) � � . _ __ �...w�m, aaY. Y��
� FWI rasitlent a0dress W a number anO stree4 �y. s+ate, anC 2!P mtle)
17�1? � Sr�' 1`�,Qi✓F
Pe�son auNO�aed Oy dWy exewtetl Power of AnvneY a M IC 67.1-12-0.7
Pddress ol auNarzed ce� (numDer aM sbeat ary. s+ate.
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