HomeMy WebLinkAboutMortgage_Kelle"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R11 / 8-09)
`�w Presmbed EY DeparVneM af Laal GmemnreM Fi`wre
Fil
wsraucnoNS: "
b be fikd in person or b mail wiM the CountyAuditor or Coun Recwder o/ fhe wun where the F� ���U ���t�
Y b ty WoperN is �ocated. �\I oelnry nddt(dY
FTmg Dates: 7J Real Property: Must fife durng Ne year for which the deductan is wughG ��
2) Afobr7e /Manufactured Homes nof assessed as Real Properly Must Ae dunng the fweNe (12) monMs
6e(ae March 31 of each year Me deduclion is sought. ❑ Counry Recorder
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See /everse side for addifionel instrucl7ons and quali(cations. /i � j �°' .
AppGam(ownua byer-see miawrseada) GIBSv�� CGUNTY :,UDITOR
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T' istria rcmibrl l legel desa�tion Rxad numDer Page n�rt�i
� a-� - 5-�00 -o�y. ���-oa7 aoio y
Atxssed rdhre d real P�P�Y as d Abrtpage / Contrati 4d�tedr�a unpaid ac of Mortgage / Contraa uMebtedness �mpaid as d is Ihe aOP�� Ne sok
MmUi 1, amnl �ear Mamh 1, airerrt yeer date of appaation legal ar epWbde owrmft
/ 9 967 � ❑ res ❑ No
m� r.t�at k tus! 1� e�cY
If name on remd's ddferent than Nal W app�renC hW'vate be6�!
Name af matqagee «mnvxt seiler �� „
MNess d rtnrtqagee w mnuaG se�er
w othr! awner rn
ePpGUnI oxn prOperly in any other
Y � ���� ❑ �
❑ Yes
DraucOOn aPWrn'ed in tlie amouN of:
20 _ 20 _
Sig(ahae of Camty Auditor
antl LP mtle)
I( yes. whet munlyt
, i �o�
20 _ 20
swneane ati,er ww� sp«ne. 6,e�te wim wMm
�Is tl�°e P�rtY N Guestia�: M�weOy Asses,ed
�t5�� �'KY ❑ Mnu�Y A�ssed
Dt-atyer- i\'O...o���
Wtat Ta .
— c�t��,�.o... �33cy�.....
\UDfI " • •
`��9 99S ���.......
— 20_ 20_
Oam (maRn.
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n
+�Y
� No
I I We cenify under Ne penalry M perjury that the above and foregoing intwmation is we and corteu aM that the applicant is a resident o( IrMiana aM
I mnvaa buyer of the atoremer�tioned P�PertY on date aPdwation is filed.
�rapye ( �q��C��am/�� Date (rtmN. OeY. Yes�
�}� A.._' 1 l � . ��D !/-A- //i
F3 3��a �,w,�,�,a„A. �.-Le�7.LP�� %�:�
Person autlamed Gy dWy exewie0 Power of Y� bY IC F7.1-12-0.7
AECress ot aN�or'¢ed 7e�+ (numbe� antl sneeG �: smfi, eM ZIP mde) .
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