HomeMy WebLinkAboutMortgage_Romershausen (2) F°,:._ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-; FOR DEDUCTION FROM ASSESSED VALUATION
-v''' 7 - State Form 43709(R11/fiO3)
I, IL ,JD
Prescribed by Department of Loral Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locateq q Form Dun with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. H P R o O Bil a County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
. before March 31 of each year the deduction is sought. ❑ Court Recorder
See reverse side for additional instructions and qualifications.
A11p51ant(0 -r or contract buyer-see re, ' on re side) (ARSON GOU fY AUDITOR
/_ _' a.. • tas' a Ste . . _ _' 4d
T lung ristrirs Key number/legal esaiption Record number Page number
/�ati�. �- Olio - >t -,36 -c/o pz_000. A7 ( -009 ao r 3 !y3 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
7 Dnn ❑ yes 0 N
If n o,what is his/her exact share of interest? If owned with someone other spouse,indicate with whom
If name on record is different than that of applicant,indicate below. I t e pro in question:Annually Assessed
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