AF-LC - 45199-, - � 10�1� G "�
PAYABLE 19� papena�rk Proofed
lAew Plat ontract for De �S� �
� Division Warranty Deed ,�.
Combination uit Claim Deed o
, Add as Omitted Request '
Date of Transfer � Other, specify
Special Assessment Funds � .LL.1 � � � � � � � � 1.1�..! t�.LJ �
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Plat Name : � � � � � � � � � � � � � � � � � � � � � � � � � � � �
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The following Parcels are now out:� � 7x .
PIN (s) - Key Delet by Date
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The new Parcels are:
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DDivision
a Combination
s
Fee oM�nez : __
Contract purchaser:
Taxpayer na.mec
Address:
PIN
DIV1�]Ot: / CC�MF+7NA'T701: RF.Ai�i:`'T ,
! Datc� � •,
/ �/
Municipality
For taxes payable in 19�
�'Jl1V'� d✓�
o��/'�� '�� �%-60�/
IAT 1 BLK
2-y -3o-a`I -a�-oo
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SUBDIVISION OF DESCRIPTION
Note: If this is a request for a division of a tax pazcel, the legal
descriptions of the new parcels must be attached.
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Fee owner �] Contr puzchasez _
Note: If the request is by a contractheuco tertaxhrecozdsCOrtamc pyaofethe
appear as the contract purchasez in t Y
contract foz deed must be attached.
OFFICE USE ONLY:
Checked for delinquent taxes by:
Date : / � �
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