HomeMy WebLinkAboutMortgage_Grubb (4)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
� • Slate Fwm 43709 (R71 / fi-09)
•S �.�. ? PresrnbeO M�P��ent of Locai GorertuneM Finarce
INSTRUCTIONS: qm eq�py�
To be filed in person or by mad with the CounryAWitor or Counry Rewrder o! the county where the pioperty is located. N O 1� LU I C
Fi7ing Dates: 1) Real Property Must file dunng the year (or which the deducfion is soughL �� Counry Audimr
2J MobAe /Manufadured Homes rrof assessed as Real Property: Must file during fhe nveNe (12) monfhs C n Recorder
6etore March 31 of each year the deduclion is sougAG ry
See reverse side for additional instructbns arrd qualifications.
AoMw�t'lUwne� w contract buyer' 3ee reibilW�s m reverse sidel .
Oa..�z..-�� a6-��i-[ �_303- o oo. � � 3-oo � aor a-
Assessed vafuc d real propetty W Morcgaga / Contrat14de6teCness unpaid as ot Mortgage / Contraa iMehtedness unpad as of Ls'
Ma�d� 1. arrrnt ym MarM 7, qu2nt yeer date of appGCatbn le�
Q � 0
n m. what Is nis � ner eraa share or interest9 �r mm,ea wim sameone ou� sao�. iMxare wim wlwm
tt nama on recoN is drtfemnt Uan inai ot aOP�t btOk
Nama of rtartgagee or contracc setler � I
Addres oi mort9a9ee a conNari se0er (num6e�ard
Name af assignee or atlml owner w twider ot mortgage
A9d2ss of ssignee (number a� stmeL ciry, sfats, erw
lt `J
Dces'appGmnl own property in any oNer
�,�cy m i�am�a
❑ Yes ❑ No
D�Luctian app`m�ed in �he amount aY.
20_ 20_
Sia�GneofCounNAWitor �
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uy, state, andLPcode)
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aroperty ❑ nrmua
Mob�e
Page �wwmbu
S�a�
Yes LI No
Tating D"str'vY? I Ha5 ihis tled�»im Eeen re9uested on ptapeny
r� a,�,e�u ywn
n_�a�_❑_
COUNTYAUDROF �
Dra���erNO..t�'•�••••••••• —
20
�«,�a Card 1\TO. .. �l.l�.�••1........ —
I/ We certify urder the penalry ot perjury�P(at Ne abo foregoing infortnation is N
owner I contrad buyer of the aforementioned prope date appiiption is filed.
�reLUe (ovme/s /u0 neme)
�.11 � �. �g,././
m Rsiaenc aeaess w epp&ant (nurnner ane street �r ��. �+e z�a oode)
.� n .. _ ' . � �f / / / Li /i / i i .. . i .�
Date (monfh, day,
Date (mon1A. daY. Y��
a�
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(numDer ana sLeef, city, sfate, aM LP cnde) . I /