HomeMy WebLinkAboutMortgage_Bailey (2)"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ship
..,_ -
� FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fortn d3709 (R11 / fi-09)
�' ww Presvibed by Departrtrent of Lod Govemrtrent Frence
INSTRUCTIONS:
To be �led in person w by mail wifh [he CounryAUditw o� Counry Recortler o! the wunty whe�e fhe pmperry is located. F� fl$�w�`E "�S
Filirg Dates: 7J Real Pmperty: Must file during the year fo� which fhe deduc6on is soughL � �u r
2) Mo6de / Manufactured Homes lpt assessed as Real Property Must h7e dunng the tweNe (72) months
6efore March 37 0l each year the deduction is soughG G I S0� Ol�T�3fy./d�81r80R
See reverse side !or addifional instructions arM qual/ficafions.
MaV� (�roroontrae buyer - syg reshicJje�ns an rever�sy side)
1`
X
a�-
f vWue d real p�operty as of
arrentyear
no. wfiat's his / her e�U share of interest?
artent year
11 name m rt.md is E�irterent tlun tlal of appGpnt. uMicate Celow.
m m�traG se0er (num6ei and streel, rdy, stam, aM LP aode�
Name of assignea or Whu awner w holder of mortgage �/
� X
PddRSS of aS.ignee (number aM stree4 dy. sfale, aM ZIP Cotle)
Does epplimnt ovm property in any oNer If yes, what �
1 nry in Irdana?
❑ Yes ❑ No
DPLucuan approveC ui Ihe amouN ot
20 _ 20 20
sg�awre w c�ry a�a�t«
D. �7�-oa�
> of Morigage / ConbaC uMehG
date o( appGcatian `�.
unpaiE az ot I Is Ne epp4�ant the sole
W
legal or equila6le oxnM
❑ Yes ❑ No
If owned wiN someorie dhu Cun sppae. iMkafe wilh xiwm
COUNTYAUUROR
20 _
I/ We certify ufWer Ihe penalry of perjury that ihe above arW foregoing infortnalion is tr
owner I contract buyer of the af«ementioned property on date appliption is filed.
mature (owneYS fiAI name) n �% • /
by Cuty
Pawer of Attomey or by IC G7.
person (num0eralN street, dry, sbte, entl ZIP cade)
k ProPertY in Vuestirn: MnuaMl�sses.uE
Real RoPenY ❑ �^�Y �
Mod'le Hort�e (IC 61.
irl? Has Ih'a deduction Deen re9uested on property
toraureHY�r ❑ Yes ❑ Ni
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