HomeMy WebLinkAboutMortgage_Rexing (5)""+v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_�_,. � FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-09)
�' ,w e p�¢�betl M�G��e�rt a1 Lxal Govemment Finance
F
INSTRUCTIONS:
To be h7ed in erson or b mail wifh the Coun Audito� o� Coun Rewrder o/ the coun where the m F� � (� �
P Y h �Y b P PenY is located. �'
Fdilg Dates: 1 J Real Property Must fi7e durirg the year Por which the deduction is sought. un ttu rtnr
2) Mo6i/e / Manufactured Homes rrot assessed as Real Property: Must fife dunng Me Rvelve (12) months
before March 31 0l each year the Ceduction is sought. Counry R er
See reversa side Sor addrtmnal instructkns arM qualihcations. �����I�p-�
',AUafimni(o 6uver-see�e5�icbro�smmvem'9sidel . """"`�'�� I
istriG /1 OCn�h���g d`^ I_��O—QO�U�1p\'_ .�I Remrtlnym� Pa9ewm �
�./ 6 .s K, ,
t
I vahre aFrral yopMy es o( Mw�a ge / Cantraa'uWehtedr�s unpaid as of Mongage / GntraG hiEebteEness unPaid a of Is Ne aOP��t Ne sde
ar�ent year Mart�h 7, artent yeer tlate oF appGratbn legal or equitable amM
❑ Yes ❑ No
at ts ha! her e�a0 share of interesi? H owned wi� someone oMu Ihan spouse, indlnte wiM whom
of mwtgagee a contrxt seller
Add�css ot rrort9a9ee w oontraU
Name of assignee w other owna
c
ard sheeG �1: uem. ard LP code)
>f as99nee (numbereM skeet Nry. slate, and LP � 1 � �.M � � � �o S ,� ' �
L MV
ilifant own property in eny oNer If ye
Indmra?
❑ Y� ❑ No �p_�r5 73
Deductlon app`oveE ui
20 _ � 20 _
Sig�ature d Caimb AuEimr
1 I We certiy under Ne penalry of p
awner I con buyer of the
' renue (a name)
F � entaddress fa (num r,
Pessan auNOr'¢ed W dWv :etl Power
20 I 20 I 20
Is ihe property in Ques6on: Mnw
❑ Real Property ❑ Mnual
MobOe
leduction Ceen requested m property
��n ❑ Yes ❑
20
Date
20
that ihe above aM toregoing intortnation is We and wrtec[ arM that Ne appliont is a resident of IrW'wia and
ned pmperty on date appliption is filed.
. � _ ._ Date (+ronth, daY.1'se�
state,
authu'ved perwn (numberantl sLee; dry; state, aM LP code)
Data (monfi. OaY. Y�� ,