HomeMy WebLinkAboutMortgage_Hoover^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
• FOR DEDUCTION FROM ASSESSED VALUATION
�' � State Fwm 43709 (R71/6-09)
•S � Presrn'bed M �eP�nt of Lnmi Govemment F�
INSTRUCTIONS: pw �d
To 6e filed in y mail wifh the CountyAUditor or Counry Recorder of the cnunty where the property is bcated. �m 1��Q�Z
person w b
Fi6rg Dates: 1J Real P/operty Must hle durirrg tha year (or which the deduction is sought �� County Aud'rtor
2) Mo6r7e / Manufactumd Homes rrot assessed as Real Properiy: Must file during the hvelve (12) months ��e
befae March 31 of eacFi year the deduction is sotxPub.
See reverse side for additiunal instrucfbns and qualifications. � _____
�������
Marrl� 1, aureN year
I( ro. whal ts ha / trer eraU share Ot interesi?
If name on remrE's E'fiuent Nan Wt oi aDpi
Name of rtwrtgagee a contraC seUer �
rs\e/ sile) � ,
T
a , oo�. -od
/ Contrac['udehtedrcess unpaid as of Mongage / Con i�E
airtmt year tlate of appfi�'
If wmed witl� someo� o tl�an
Ee4bv/.
Address of rtwrt9agee w canbact seller (num6er and svee4 Gly, sta'n.
w
Does ePD��m� � P�DertY in any oNer
munryinlnd�ana? ❑ Yes
of rtwrtgage
slate, eM LP cotle)
What Ta�dng Distriq?
unpaio as d
�ipWe ovm�
Yes ❑ No
sPouse� o�dicate with whom
�s D�oPertY m question: MnuaAy
Real PfoPeNY � %!rm!�al�' �
��'
Has this deduGan Deen 24uested m G�P�Y
for artent yeaft
❑ Yes ❑ No
DeducCOn appmved m iha amwnl of
20 _ 20 _ 20 _ 20 _ 20 _ 20� �
�� � N � ,��, ma ���,,-rs�
SignaNre W Coimry Auditar �
/
I/ We certify urWer �he penalry of perjury that Ihe above and (oregoing infortnation is W e: J�u��
amer I contract buyer of the aforementioned property on date application is filed.
����'�����
redEent ' W appOCant (number an0 sbee( dry, state, eiM LP e)
��I �f� E%oo S oaK�a�d G�y /n/ Y�l�(so
ey ic �,
per,An (num6erandsbee;
%� � �3g