HomeMy WebLinkAboutMortgage_Kramer (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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; FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fortn 93709 (Rtt / 6-09)
� wr � Presai�etl by DePartment of Locai Govemment Fulance
1�
INSTRUCTIONS:
Fortn filed �vj(q:
To 6e filed in person or by mail wifh the County Audifor or Counry Recoider o( the counry whe2 fhe p�operty is located. � ,j
Fifirg Dates: 1J Real Pmperty: Must file during the yearlor which the deducGon is sought. AP �Z��unry Auditor
2) Mobde / Manufactuied Homes not assessed as Real PropeRy Must fiIe dunng the M1veNe (72) months
6etore March 31 of each year the deducfion is soughL C unry Recorder
See reverse side for additional instrucUons and qualficafions.
InppGram(ownero�artbuyer-seeresuicears�ryreversY�e) GIBSON COU
UI¢31 popa;y es d
ShNB Of i111ERSl?
IO??�:s^
�9a9e/ContrarY
M2tU 7, ayent Ye:
1 . J� � �i� �
unpaid as of Mortgage / Conraa
Cate of appGmtion
numGu
legal a equitahle axneR
❑ Yes ❑ No
1/ owned wNh someorre ather Ihan spouse. indimte with xiwm
Name ot rtnrtgagee «mnttad seller C� �
J
Address of n�[x[gagee q contraq se0er (number and sLee; ctiy, sfate, aM ZIP code)
Name of assignee w other ovmer or halder of ��e ,� �
AACress of assgnea (num0er entl atrect �Y, l�/�/T,4 /� �I�� /�� �
�J �..
Does a�iwit wm property in airy aher
��„� ���, ❑ Y� r ��//- /G.��
DrdurSion aPWOVM In Me amount oE
20
Sig�nue af Camry AuCitor
20 _ � 20 _ � 20 _ � 20 _
Caunry
Is the property in Questiorm MnuaOy Assesse0
❑ Reai aioPe+ry ❑ MnualN A�sed
yrar.
2b _
Date irtmth, daY. Y��
��
20 _
I I We ceNfy under Ne penalry of perjury that the above arM foregoing infortnatlon is W e and mrrecl and that the applinnt is a resident of Indana and
owner / co tract buyer of the aforememioned property on date appliration is filed.
narpre (owngrS hAname) . Date (monN. daY. Yea�
tlry, slate, arM ZIP ootle)
Gy tluly e`ecutetl Power
person (numbera�M sLee; tlry. sfate, aM LP wde)
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