HomeMy WebLinkAboutMortgage_Kruse^^n STATEMENT OF MORTGAGE OR CONTRACT IN�T�D� �
__ ; FOR DEDUCTION FROM ASSESSED VALUATIO
State Form 43709 (R11 / 6-09) A P R 2 5 2
� ! Preuribetl by DePaRme�n of Wpl GovemmeM Firence
�NSrRUCnoNS: c.�.n����
To be fiied in person or by mail with fhe CountyAuditor or Counry RecoNer of the county where the pro ted.
Filirg Dates: i) Real PmpeAy: Mus! file Uunng the year Por which fhe deduc6on is;PR97t�. ,�������
2) Mo6i7e / Manulactured Hwnes rrot assessed as Real Pioperty Mus'Piika4,}Ai
befae March 31 oI each year the deduction is saght.
See reversa side /or additional instnations and qual�catbns_
AppGnm(o�fner trartbuyxr-seerestrj�wumre ' e)
Tadig
e0 vahie af real poo�eerty as W � - Mortpage / Cont
1. armnt year Marrh 1, artenl
a�
�hai Ls his I her e�1 sliare o( interest?
: on remtl's dMUen� Nan Ihat ol appOmr�i, i�Mifate belaw.
Name m _ ! � � se4er
\
Pddress W rtnrYjagee ar wntraG seAer (n�mher and streeL �Y• std�.
Name ot assynee or oMer owner w holEer of mort�age
Atltlress oi assignee (nLmDer antl snee4 �y, slate, and LP catle)
Ooes apptinnl own property in any other If yes. wha� m
appfwtW in ihe amoun[ of.
20 � 20
J
20
��
az
File Mark
Fam iBed with:
unry Audimr
Counry Recordes
Recqd number � Page numEpi
r epuilade axneY?
❑ Yes ❑ No
perty in OuesSOn: MmiaDy As,esseE
ProPertY ❑Nmual�YASS�sed
Di'a�vCr \O.u�.U.�.�. ....
,�,T��o��, � y a y
car-� �o . .....................
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"Pi���iq
naMd d Camry AuEitor I Counry I Date (rmuh. daY Y��)
I I We certify under fhe penalry of perjury that Ihe above and toregoing infwmalion is we and cortect and Nat Ne appiicant is a resideni of Indiare arM
owner I contrad buyer of Ne afaementioned property on date applicatlon is filed.
�(awne/s hA nam@) � Date (rtunfh. daY. Y��)
identaEtlnressofappLnnt(num2Derantlstree[,ciry,sfate,aMZlPootle) ,/ ��� �
��77 � �J-SU•S �rGnc,�sco, �/l/.
auC�ttrseA by O�dy ezewted Power of AUaney w by IC G1.7-12-0.7
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