HomeMy WebLinkAboutMortgage_Traylor� NSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship Year �
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43709 (R11 / 6�09)
�' y,� PresrnbeA by DePaM�N o( LoCal GOVemment Rnance �
File Mark
wsrRUCnonrs:
To be filed in person er by mail with the CounryAUditor or Counry RecoNer o/ the couniy wheie the pmperty is kcated. F
Fikrmg Da[es: 1J Real Pmperty: Must file dunng the }rear /or which the deduction is sought. C� Auditor
2) Mob�7e /Manufactured Homes rrot assessed as Real Praperry: Must file dunng the tweHe (12J months ❑
betore March 37 01 each year the deduclion is sought Co er
SeeleversesideforadditionalinstnlcWnsandqual'dications. GIB AUDITOR
nl�wnerp�pontpdbuYH-seereshcWOSqnrere�side) _ /1 / .
vi� —
eC vWte dRal Po0&b as ol �
1. ae'eN year �
If m, what a Itis / her e�a share of inte,rest?
It narne m fecwd is Qdfemnt than Ihai al aPpbcant,
Name ot �nrt9a9ee or mntracl seller
Address of rtrrcga9ee or contrad se0er (monbar ar
Name ai ass'gnee w oNu awner w holder.
nea� a, �� ��„�, �e �c m,
Dces applinnt ovm property in any oNer
munty m IrW'gna? r
❑ Yes L
zo � zo
�7lO'o9UU-L
r � Contraa 4dehtea�ss
wrrenl yPar
L�: s�, erd LP oode)(
az
�f owned with someofre
� .....
Dra�ver \0... ��I
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Card �O j••g .................
19 ►, 3 `� �—
Zo_ � zo
Caunry
2�
iMeCtedness unpaitl as o! Is Ne applirant Ne sole
/J iegal ar epuitade oxneR
l/�� ❑Yes❑No
�e 7roPeKY in Ouestion: MnuaOy Atisessed
Real Property ❑ NmualiyAssessed
s ihis dedutlion Eeen reqursted m property
currem yean
❑ Yes ❑ No
20 I 20
I I We certify under the penalty Ot perjury that ihe above antl foregoing infortnation is true and mrtecl aM that the applirant is a resident of IrMiana and
owner I contraU buyer of the a(orementioned property on date appiira0on is filed. �
� a9naeue �o ers may
� FiID msident ppl�
l
Persq� auNp¢e0 Dy E ezi
Address of autharaed pe�son
and ZIP
tily, S�afe. and LP mde)
-iN c��►�3g
Dale (month, daY. yaa�
Date (monfi. OaY. Y��