HomeMy WebLinkAboutMortgage_Kern""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C n w hip Year
�___ _; FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Form 43709 (R17/6-09)
�' �w PresaiGed q' �eGaMieM of Lotal Govemment Finarra
File Mark
INSTRUCTlONS:
To be fited in person w by mail wiM the CountyAuditw or Counry RecoNer o� the counry where the property is loca� F ���
Fifing Dates: 1) Real Proparty: Must file during Ne year (or which the derlucfion is sought. � Counry Auditor
2) Mobde / ManWactured Homes irot assessed as Real Property: Must file dunng the fwefve ((��(b�OU TY DITOR
betore March 31 o/each yaar the deduction is so/ghi. County Recorder
See reverse side for additionel inshucGOns and qualifications.
T Distrrtt Key mmbu I Iegal Eesciption R¢md numEU Page ny{2be<
-18-.�� -yo3_oo0. a-S�-�O So� �
A�sed v�ue of rral popeny as of Mortcage / Contraa Indebte0�ress unPaid az of Mwtgage / ConYact "v�0ebiedrress �mG� a d Is itre sPP�+t Me
Me�ch 7. a�ma year Mard� 1 n�rtem year date ot avP�� le�l or eWitade oxnelt
Q � � [% ❑ Yes ❑ No
tt fw. what ls his / her eva� share o( inlercU? I/ owned wiN samm�e aher than spouse. mdr�e �`�'^— . _
If riame m remtl iv Ctlle2nt ttan Nai o1 aCP���. 6kira� below. ('� � y.�'A D —
/°7CP U � �
l/° 9 aoion�
Name of mortgagce or crntract se0er �� • tK.J'^ J �' 3�-'� "> i
Addrea d �mtqagce w mntraU se�er (nunbrJ end streaL �Y. sb:e. and LP code) 'R ���� .��
Name of azsi�ee w dtrer wmu or Midu of rt�ortya9e
Maress of asvgnee (numberaM sbeet �=Y.
o� a,�a�,�,e.�,. �
�n�r � i�ea�? r-�
catle)
u yes,
�J
Oistrict7 I Has Vus
far mre
v�rtr
❑ No
COUNTYAUDROR
Deductim app�wed in tlm amount af.
20 20 20 _ 20 20 20 _ 20 _
Sigruture of Cmmb AuEimr n Counry Date (monN, daY. Y��
<J
I I We cerafy u er the penalry of perju at Ne above and foregoing intortnation is true and mrrect and that the applinnt is a resident of t�iana and
owner I contraci buyer of ihe afaeme neC pmperty on date application is filed. �
� �' ( rg�W rm ) Date (monlh. daY. Y��
�(
X F revAenc aEtlmss of appfmant (numDer and sbee4 �ry, s7afe, end ZfP oode)
q 5 ., L ti. /fti.� 6� .rv Y7 G 3
PrJSOn autho�¢ed Cy dWy e:eated Pouer ol Attorney w by IC 61.1-12-0.7 Date (rtron(h, daY. YE�
P4Eress of author¢ed pert.on (numDeralM sbeef, tlry, state, end ZIP cotle) .