HomeMy WebLinkAboutMortgage_Kruse (7)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION /
• State Fam 03709 (R71 / 6-09) v
�' Presvibe0 y' Departrne�rt a( Local Govemmem F�
�
INSTRUCTIONS:
Fq m��ith:
To be fiied in person w by mati witli the CounryAutlitor or Counry Recorder o7 Ne county where the property is locaf� V �1
FIl'm�j Dates: 7J Real Property Musf fde durrrg the year /or which the deduclion is soujAt �/���y q�a��
2) Mobde / Manufectured hbmes rat assessed as Real Property Must fi/e dum'g the nveHe (12J months
� before March 31 of each year the deduction is sought. '�i� � -���Y R�ef
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See �e side (or additional inshuctbns arM qualificatans. , , !, , _,__ _
Distria � Key nmoer / Iega1
Assessed vahe dreai P�OeRY � d
Ma�U� 1. anmtYrar
If n0. wha� ¢ his / hM exad sheR 0( interasi?
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Remrd Page ruun0a
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irde60eO� unG� as W Mortgage / Can�C uWehted`mss unD� as of Is Me �P�t ttre sde
v� I. �., ��.-� tlatB of appGation 1eg21 OeQUilahle �
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Addless d rtnrtgagee a mntrad amei (� eM v..-• -" I LP code)
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I/ We ce�fy under thepenal
owner I m�itrad buyer of Ne
Sig�anue (own neme)
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FWI msident W epp�rant (r�
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Penon authotaetl Dy O�N exeate�
P4Crass of aW�ortred person (nurt
What Tadrg D'strirt?
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Is Ihe C�G�nY in 7uestion: MnuaOy Assessed
❑ R� �oaenv ❑ an,�;aM as�sed
Na detluction Caen reQuesleE on p�ope+ry
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perjury above arM foregoing infortnation is true and cortea and Mat the applinnt is a residerrt of Iridiana antl
:me ' property on date application is filed.
Date (nnnCi. daY. Y��
i - -�v
� a S dN, �ta. and ZIP ootle)
� E v s r �17� U�
� of Atlomey or by IC 61.1-12-0.7 �ete (/nar�h. daY Yaa�
nd 5bB8; City, state, and ZIP mtle) .