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d�•�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township � Year
a._ ; i FOR DEDUCTION FROM ASSESSED VALUATION
3•�� SlataFOrtnt3709(Ril/6-09)
�"�' PrescnbeE by Depanment af Loral Government Finance I
File Mark
INSTRUCTIONS:
To 6e fifetl in pe�son or by mail. A P R o f cn:
Filing Dates: 1J Real Properly: Must be complefed and dated in fhe calendar yea�7oi which the deduc(ion is soughf. Count Auditor
Must be filed with tha CountyAudifor or County Recorder o7 fhe county whe2 the pmperty is /ocafedC � Y
on or 6e%re January 5 07 the immediafely sucteeding calendar year. unty Recorder
2) Mobile / Manulaclured Homes not assessed as Real Property: Must fi/e wi�h the CountyAudiror of the
counry where f6e property is located dunng the fweNe (12) months 6e;ore March 37 o/each 7�a�i�i�N COUNTY AUDITOR
detluction is sought.
See ieverse side !or additional insfmcfions and qualificaGons.
Applicant (owner a conbact buyer - see mstncfions on reverse
Brian C. Klump and Katherine M. Klump
Ta�drg Disirid
Haubstadi
�$161,500.00
It no, what is Ns / ner euM
I( name on recortl is diPerent U�an Nat
Key numCeN legal tlescnplion
26-1&36-403-000.667-009 Lot 16 West
Mortgage / GonUatt v
March t, wrrent year
David W. Becht, Jr. and Debra J. Becht
Name ol mortgagee or mnvatt Seller
Franklin American Mortgage Company
Adtlress of rtrortgagee or convatl uller (num6er aM s✓eef, ury, sLafe, and ZIP ootle)
501 Corporate Centre Drive, Ste 400, Franklin, TN 37067
Name of assi9nee or other owner ar holder of mortgage
end sfreeL rity. sta:e. arrd ZIP code)
as
4th Addtn
as
spouse,
�itaUe owneR
Yes ❑ No
Is lhe property in que5aon: Mnually PSSesseO
�❑ Real Property ❑ MnuallyPssessed
Mobile Home (IC 67.
I Does aPpliwnt own property in any other I II yes, what coun,y? I YYhal Taung Disina? I Mas inis tleauctan �een requestea on property I
counry in Indiana? ❑ No tor cunenl yeaR
❑ Yes ❑ Yes ❑ No