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^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.r°
• FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fotm 93709 (R71 / 6-09)
�' µ� � Presalbed M DePartrtrent of Laml Govemment France
File a
wsrRUCnoNS:
To 6e filed in person w by ma➢ wiN the CowtyAuditw or Counry Recorder of the county where fhe pmperty is bcated. F� ��r �(`�� n
Fd'u�g Dates: 1) Real Property Must fJe dumg the year Por which the deduction is sought. � C'COUn� ��i�
2J Mo6Be /Manufectured Hanes rrot assessed as Real PropeRy Must fi!e during the M1veNe (12) months
before March 31 of each year the deduclion is mught. ���. �
See reverse side for additional instnxtions and q tions.
MoGCant(owoeforirnC•ae6uver-sea�Spicti�s le side) COUNTY AUDITOR
I( ra.
P�P�`/ �
aesmp
- -�Ud./ � -Do�
�e/ Contrari inde6tedness unpaid az af Mwtgage I Con� udehtMness
, curtent year tlate of app�qtbn
tt awned wi� someone other Nan spouse, u
ddferent Nan Nat of appGrant, trditate Debw.
Name of mortgagee or ConVact seibr
Add2ss M nnrt9agee ot mnbaa seller (num6e� aM streel, ciry, s�'e, ard 21P code)
Name of assi9nee w other awner w hdder ot mwtgaga
�
Addmss o1 astignee (numbu aM stree; dry, slafe, aM ZIP catle)
ooes epplimnt am properry in eny -- - -
counry m Indrdna? i"I .,_ _
D�ucCOn
20 _ I 20
Sig(aLrte W Co�mty P�uGaor
I/ We certify under the pen:
owner % mntract b}Fjer of th
�d u �<
eyawye:ean
xd pp�sen (n'
r__� no-.�.n .I Has
;�Jue� �Ui�? - C� a lf�
�
�nt Ne sole
iitaWe ame(1
Yes ❑ No
p¢rty ul QueStion: Mnua%ASSessed
RoPertv ❑Aimua�hAse�
m propetry
❑ No
20
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