HomeMy WebLinkAboutMortgage_Pugh (2)ry�STATEMENT OF MORTGAGE OR CONTRACT IND ES 7ovmshi Year
9• FOR DEDUCTION FROM ASSESSED VALUATIO � P
� State Form 43709 (R71 / 6-09)
4` w�. �� p�¢safhed by OeP�ent at Local Govemment Ftance
N�� 13 ZQ�2 FileMark
INSTRUCTIONS:
To be filed in person w by mail with the CowiiyAuditor or County Recolder o/ the couniy wFiere 7F% located. Farm Ned wiN:
Fd'ug Dates: 1) Real PropeRy: Must file during the year Por whicM1 Ne deduction is soughG �i unty Auditor
2JMo6Ae/ManufaduredHanesrrotassessedas�Re�ahProperiy.Mus��dyN10UNTYAUDITORs ❑ CountyRecarder
before March 31 of each year the deduclion is S�� �%
See reverse side for additional instruclbns arM qualifications.
� p'1�-I(-�7- �FO
� �24�e d paperty 1 Mwtnage /CCCppp ntrarY indebteGfress unpaid z
1. acmnl Ma� 1'�r4Ct yearDO ^
a�u�/ � U
7 m, what Is 1� ! Mr e�md share ol intelest?
tt name on remrti is ddferrnt tlwn ihat of appl
Name of moROaoee w mntra<Y setler
Address ot mortga9ce ar mnVad seDer (numbe� and sLeel, ciry, ste�,
� a� ��
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dinnt wm pmperty in any other
Intliena?
❑ Yes
slate,
.r.�
�
b0 5� 8<
Mongage/CoM�
date of aoDfmati
H a+med wi� someone other Man spouse.
RewN numbel
numbu
or equitade ovmeft
❑ Yes ❑ No
Is ihe pmpnny in question: MnuaM Assessed
❑ Real RoPeriY ❑ i4mua��Y Asseised
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Card NO. 5� � �
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