HomeMy WebLinkAboutMortgage_Wood^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Form 43709 (R71 / 6-09)
S,� PreSCibeE by Department ot Lmai Gm�emment Finance
INSTRUCTIONS:
To 6e filed in person w 6y mail wiN !he CountyAUdito� or Counry Recorder of the counry where the pioperty
Fi7irg Dates: i) Real PropeRy: Must fi!e dunng the }rea� fir which (ha deductlon is sought.
2) Mobde / Manufactured Homes irot assessed as Real Pluperty Must file during the hveNe (
6efore March 31 of each yeat the deductron is sougAt.
See reverse side for additional instrucLOns and qualifications. �
��6pnt (owperor ymLaU buye!- see rcshi7A'� � reverse vdp] /�
Asgs¢E vdtu¢ Of Ral poperty a N M age / Gontr9G u
Ma�tl� 1. qmer¢ ymr 1. curtent year
If ro. whal is his I lrer exart share Ot inteiest?
tl tame m �emd is difle2nt than that of appBmn� ud'vate helwr.
Name ot mongasee or mntraa s�
Add2a of rtnrtgagce or contraa
_ 000. �oo2-D - Got.L
krress unPaid as U Moh9a9e / Conraa
If
Recortl numbu
btedness unpaid as of Is Ne applimnt Ne soie
legal a epuitaWe ownM
5 `�((a ❑ Yes ❑ No
spouse, iMirate wiM wtrom
�RIs P�GenYinQueStion:MnuaOyl�ss¢s5e0
eal ProPe�Y ❑ M^!!�Y � . . _
Name of assignee w otlrer owner w holder of nprtgage
Addfess of assi9nee (numDer aM strre4 �Y, stete, antl ZIP code)
Ooes epplimnt own property in any oNer If yes, what muntyt W�at Tadig D'aUii? Has Nis dedurYim been repuesteA on prapeity
munryinlMiana? ❑ Y25 ❑ NO -----_ __ " _' torwrteMY�R
^u-y.'—`��4��� ❑ Yes ❑ No
w/�V`t.uK7
. f
Deductionappmvedintheamoumot Dra��'CI' 1i�... .oJ.�......
20 _ 20 _ 20 _ � / � %� 20 _ 20 _
Card NO. ....G.P.a4�.S
�����,ry,�� �95,�3�.a?...... ���„�,,.�y,��
I I We ceNfy under ihe penatty of perjury Nat Ne above and toregoing intortnatlon is we and correc[ and that ihe applirant is a resident of IrNiaria arul
owne_r I contract buyer ot the aforementloned,q.opeRy on date application is 51ed.
_. v ...T...-.... .. .0 i%�
P�wn auUro�E Gy dWy ezewie0 Power af AttorneY or by IC G7.1-12�.7 Date (rtronN. daY. YEar)
/ddress of aNhomEd pelson (number aM SOee; tity, State, an0 LP ootle) .