HomeMy WebLinkAboutMortgage_Kaelin^�n STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
__,. = FOR DEDUCTION PROM ASSESSED VALUATION
• State Fwm 43709 (R77 / 6-09) .
S � Presaibed by DepartmeM of Lodl Govemr�rent Frerce
�u.
INSTRUCTIONS: .
To be filed in person w by mail with the CounryAUd¢or o� Counry Recorder o/ the wunry where the pioperty
Filirg Dates: 1) Real Pmperty Must file during the yearlor which the deduclion is sought.
2) Mobile /Manufactwed Homes rrot assessed as Real Proper(y Must file dunng Ihe twelve (
6e/ore March 31 of each year the Ceduction is sought.
See 2verse side lor additmnal instructions and qualifirations.
MW���(ownerwcon C uyeryteeivst�rbo^s yxrsesitl� / A •
Ymal p�opHty as
p opert
1�
no. wnat
rwne m
"oc J—I �'
Mor(qage / ContraG in
Ma 1, wrtent yeer
L iM'uate Debw.
Name of mwtgagee or conVact se9er / � (� ^
c./ J '�
AGdress of mortgagee w contracl seller (num6er arM street �y. sfete. eM i
Name ot assignee w other owner or halAer of mortgage
AAtl�ss of assignee (number eiW sheeS �Y, s�te. a�ul ZIP oo0e)
Dces apptirem wm propnny in any oNer tt yes, what munty!
munry in Indiana? ❑ Yes
❑ No
Deduction apprwcE in
20 � 20 _ � 20 � 20
_ A^^'��1 ��� I r Remrtl number Page num0u
w\% � `I
unpaid as of Mortgage / ContrarY uWebted�ress unpaid a d Is ihe appOtant Ne s<
date of app6ptim legal w eQUitade owr
❑ Yes ❑
Is tM propeny in Vurstion: Mrnia�Y Assesse0
❑ Real PmPenY � ��Y �
Moble Hane pC 6
Dra«�er NO ��.!.�.......
Card 1io. .. a59.[�.......
��,�o.�'
� I �
n reqursted m pmpMy
�
No
1-7)
�
�
�o
�
Sigrewre of Counb Audhur Counry Date (month. daY. Y��) �
I/ We certify under the penalry of perjury that Ne ahove and foregoing intortnalion is true and cortect arM that the applicant is a resident of IrWiana aM
owner I ntracl buyer ot the ahxementioned property on date application is filed. /-�
Date (nmrh. daY. Y�� , 1
W ' ent add W a n Der ntl sbeec4 dh6 s/ate, arN LP cotle)
v_ O J •
auNOraed Gy duN exewteE Power of Attomey or Ey IC G7.7-t2-0.7 Date (rtronN. day, yxa� `
'_ _ _' `/
Pddress of auNw'vetl person �numberard street, ciry, s�ate, anC LP code) .