HomeMy WebLinkAboutMortgage_Stunkel (4)� STATEMENT OF MORTGAGE OR CONTRACT INDE�D�IE�S, n Township vear
_ _ FOR DEDUCTION FROM ASSESSED VALUATION JL 8�
• Sfate Fortn 03709 (R71 / 6-09)
•�' f Prcunbed by �epartment of L.oral Govemment Finance JU N 7
"" File Mark
wsrnucnoNS:
To be lied in person or by mail with Ihe CountyAuditor or Counry Recorder of the cnunty where the p perty . F �� ��
Fifirg Dates: 7) Real Property: Must file during the year for which Ne deduclion is soughf. �County Auditnr
2) Mo6de / Manufactured Homes rrot assessed as Real Property Must file d��(7yq�t�gptl pl2Yrni�iil��7OR /'—'
6efore Ma�ch 31 of each year the deduction is sought. ❑ County Recorder
See reversa side lor eddifional instrucL�ons and qualrfications.
p(ow�rorcmfrdct buye�- see �ecfrirtiorts m reverse side)
is Keymmberllegaldesaiptirn RecoNnumbel Pagenumbri
_ -o 06 ao a (oo� �
Asessetl rdNe d real VoP�Y az of M1bnpa9e / Cantrati udebtetl�ss unpaid a W Moriga9e / ConvafY ude �mGaid as o( Is the sDW�I Me sole
� 7, �� y¢� March 7, arten� year datc o( appGtation kgal w epuitable wme/?
a � ❑ Yes ❑ No
tl no. what's his I her morl share of interest? If oxrretl wiN mmew�e other Ihan spouse. iMicatB wiN wMm �
tt rame m recaE's difie2nt ihan fhal W aGP���• mduate bebw: s C�e property in Ouestion: MnuaAy Assessed
ea� a�oPerty � am�anr a�ss�d
I�MMdIe Fiortie QC 61.7-7)
t�rtre ot rtart8a9ee or mntract se�er �
Address of rtart9agee w contrad se�er (nurribei and sbeel, cify, sfate, aM ZIP code) "–� -
Name of assignee w ather awner or hdder of mortgage � . _
Mdress ot assiqnee (number aM streeL city. slate. aM ZIP catle) .
ocesaPP�ntownPio(wtYinanyother Ityes.whatmunty.� Dra�vL'C �ro.....�1a � �
,
counry in Indiara? •• • • • • • • • •. ❑ No
❑ Yes ❑ No p
c, Card NQ, � O o�P
DeCUCtiwa in amountof. •.•••••••••.••.•.••
�.� �0�0'�. L�
zo _ 20 _ zo _ za _ 20 _ zo -� zo _
Sigrianne W County AuEitw Caunry Date (month. daY Y��
I/ We certity ufder Ihe penalty oi perjury Ihat Ne above and foregoing infortnation is We and cortect a� ihat Me appiirant is a resident of Imliana aM
owner / contrad buyer ot the aforementioned property on date appiication is filed.
Seq er's hd name) ' �� Date (monfi. daY. YaaA
FWlresidentadtl olappfiwnt(numberanCStraef.city,slate,a ZlPmtle)
o�o� f o2� . �2. h/c�,(�S-!e /.tl 4763q
Fuson auUro�'ved by Auty executetl Pawer of Auomey or by IC fr1.7-12-0.1 oa� (�. �r• ��
\Pdtlress of aWror'vEd pusrn (number arM SLeeL dry, state. and LP oode) .