HomeMy WebLinkAboutMortgage_Kelley"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Sate iam 43709 (RB / 2-07)
�' P prasmbed by Depahment of Local Goeemmerd Finance
a
INSTRUCTIONS:
To 6e trled in person or by mad with the CourrtyAuditor o/ the cou�y wheie the p/operty is bcated. O C T 1 4 2�� $
Fding Dates: i) Real Property: Dunng the 72 rzronths befae Jwe 17 W the yea� the deduction is to be ellective.
2) Mobile Homes assessed under IC 61.1-7: BeAveen January 15 and Maich 2 0( Me year the deduc6on is to be effective.
See reverse sde for addiGonal ins6uctions ard qualifications. ���� �,(„
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It rertle al leWftl �s OGlerenl U4
Name M malgagee or cmlract
Address of mortgagee « mntra
m reverSe rde)
Kay nurlfbei / legal
_1 / \i� �
Ihal of applican4 indimte helmr.
Name ot assignee a ott�er uvrwl ar
city, stale. and ZfP oode)
appicard wm po0em �� a�y ane.
y rt� Indiare7
❑Yes ❑No
cGOn app�oved in I7ie amwM of:
20�j� ZO_
GIBSON
Pege
�O � of March 1, I Is Ihe appfrant Ihe sde legal w etryifable wmer
❑Yes ❑No
If owned wiTh sameone other ihan spouu. indiwte wilh whom.
Is Ihe property in quasUm:
❑ Real Pmperty ❑ Molxle Home QC G7.1-7)
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r/\ ili0�
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�,�=.�a,�,��, � 5� (��f
I O �
COUNTY A�
20 _ 20 _ 20 _ 20
Courrty D
�� o� �
� Yes ❑ No
20
I/ We certify under the penalry of pe�ury Mat the above and foregoing informatan is hve and corred and that Uie appGnnts was / were a resident of
Indiana and owner oi tlie aforementioned property on March 1, 20
���e �pw Dala (mmlh. day. yeaA .
� i�i��if� !o -/s/-a P
by duly exewted Power af Attarrey w by IC
Address of aNhor¢ed persan (numbei a�M shee(.
Dafe (month. daY. Y��