Mortgage_Kramer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R11 / 6-09)
�' yr presvibetl by DepartmeM of Lasl GoremmeM Fumnce '
�NSrRUCnoNS: pmn�dy�m�
b be filed in person or by mad wiN Ure CounryAWitor or County Recorder ol the county where the properry is bcated. li i 1' L 0 � �
Filing Dates: 1 J Real Pmperty: Must file dunrg Ne year for which the deducfion is sought. � Counry Auditor
2) Mo6Be /Manufactured Homes rrot assessed as Real Property Must file dunrg Me hveNe (72) maifhs
be(ore March 37 of each year the deduction is sought. � Re��
See reverse side lol additional instrtxtions and qualificafions. V
IAp�ra owrarmoontraCbyer-seereYri�fonsm�e stle)
� o`Co -!7 -/ i
Aaessc7raped�paprttyasof ge/Cant
Mma� 1. w�mc r� Ma 1, nurem
% '
tt ro. whal is his! her exatl share o( intErest?
H name m rewrd'o 6Relent fhan Nat o( aOP��t hdirate Eehv!
�
Name of rt�ortqagee ar contract se4er _ y_ _
nmress d rtnr[gagee «cmo-ad
owner w
atree; tlry, smte, and Z/P
Does a�iont awi propeny in eny aha
cou�vy m InO'�ana?
❑ Yes
DaEUCtion aprywad in iha amoum
20 _
Sigrunne d Coimb N�Oitor
�_
- 3oa -000
ffi�,
� ��
If yes. what muntyt
(o-Od-% � ., oi/
age / CanSU1 trHebteCness unpai0 es d Is Ne eppOfant Ne sde
d app�5on legal ar epuhahle oxmU!
❑ Yes ❑ No
�i awned witn somewre othar Can spouse. md�te with whnn
p�operty in Question: MnuaDy Assessed
�I PrupertY Q MnuallYAssessed
/9 �% d-D P�
Whet Ta�drg Drstrirl? Has Iha deGUCim 6aen 2quate0 m Woperty
� �� �� ❑ Yes ❑ No
COUNTYAUOIT � � - -
Dra�ti•er NO.......o.Z..� �,b..
20 20 � _
Card i1'O. .....��,a —
ca� ..........
� 73 (o (� U� —
I I We certify under Ne penalry 6f perjury that the
owner I contraa buyer ot the afixeme�oned prol
K...a awnefshdname) n /
X Fu0 revEem eddress
rlo a e
s Person autlqiizv� Gy
(numDer antl shce4 dN. s+ate,
foregoing infortnaUon rs aw ............'_. __ ( ' i aM
daffi appliralion is fileA.
oace cmmm. ear. r��
ofAnnney or Cy IC G7.1-12-0.7
person (number aM sbee; dry, sfate. aM
N �. y�6 s��