HomeMy WebLinkAboutMortgage_White (6)^�� STATEMENT OF MORTGAGE OR
; . • FOR DEDUCTION FROM ASSES�
�• State Fwm 43709 (R71 / 6-09)
�` y�. � preso�bed by Department af Local Govemm¢nt F�na
n'l�'1� 1 •{ C��./
INSTRUCT70NS:
To be fiied in person a by mad with the CowiryAuditor or Counry Recorder o/ the coimty�wh'�yz�erty is focated.
FAmg Dates: 1) Real Property. Must file durirg Na year /w which the deduction is sought.
2) 6e fora Marth 31 ore�, � ma a��m is sough��� G BsoNec'�'GR���r'� Y3k�"°"ms
See reverse side fa �dd'2onal instnrcGOns and qualificafions. _
As�ed rdire of real piopelry as W
� 7. aa�enllRar
tt ro, what is his / her e� share of interest?
It nartie M �emfd
fdN3f18PAV
below
p...'--• _-�--..••�.,. �.m seJler.(number arH svee4 �Y. s7aR. aM
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tt owned wi;h sameone
spousa,
File Mark
Fortn IDed with:
Q�Counry Audtor
❑ County Recadu
Reco�d numhrl
iitabie ovnuR
Yes ❑ No
Is ihe propeny in question: MnuaM Assessed
❑ Real P(operty ❑ Amlually ASSessed
Oeen requesteE m proputy
nY� ❑No