HomeMy WebLinkAboutMortgage_Kramer (17)"'n STATEMENT OF MORTGA�E ���R'SY7DEBTEDNESS n shi vear �
FOR DEDUCTION FROM ASSESSED VALUATION
'S _ f• SUta Fortn 43709 (R11 / 609) FEB 1 S 2011
,w Pr�ai6e0 M�PartmeM of Loral Govemment Fu�arce
C ,� ^-- File Mark
INSTRUCTIONS:
To be filed in person or by maii with the CountyAUditor or Counry Re o county where the pmperty is located. F� �� ��
Fding Dates: 7J Real Pmparty. Must file dumg the ���(1�p�7atlAYl�T1EQRghG � County Auditor
2) Mo6de /ManufaUUred Hanes rrot assessed as Real Properly Must file dunng the hvelve (72) months
before March 31 of each year the deduuion is sought ❑ Counry Rewrdu
See 2versa side /or additional instructions ariU qualifications.
IAppfranl ( aonfrad byrer' aee re side)
Ta � 0' ' KeY nm0er / le9 CesaiGtim Rewrtl numDc Pa9e num0a
� -� oC�i od '`/ � �7 - o�$
As�sed value of real pioperty as o� ' Abnpage/ Cantraa indehteEnrss unpaid as W MMgage I ConiraG'uMebteCness unpaid as of b Ne applifsm tha mk
Marti� i. m�ent Yqr Mar� O1, �artent �-'1 data of aPP�� �gal a eW ilable awneYl
� n ���n V ❑ Yes ❑ No
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Sigrewre W Counbiwartor ' �.._�. �.
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rc wmea wim wmeone ot� than spouse.
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Is the P�G�Y m Vu�tion: Mm�aM Pssessed
❑ Real Pmpetty ❑ Armually Pssessed
Rlodle Fbrtie fIC 61.
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rec��e a, aro�,cr
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I I We certfy under the penatry ot perjury ttat the aDOVe arW toregoing mtortnatlon is We and cortect arW that Ne applicant is a resident of IMiana arW
awner I mntraG buyer ot the aforemerroa�ed property on date appGntion is filed.
�oaw�e (ownefs IW namel . Date (mantli. dey, YeaA
; ��Ee�and�We,ef,�Iy�stat�n/^dLPCndey/ ry,1�/
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executed Power of Ammey w by IC 61.1-12-0.7
Address of aWmr've� persm (numeerantl shcet �4Y. s+ste.
Date (monN. OaY. Y��