HomeMy WebLinkAboutMortgage_Krutz'�� STATEMENT OF MORTGAGE OR
__ ; FOR DEDUCTION FROM ASSES:
State Fortn 43709 (R71 / 6-09)
�• ? Presaihe0 M DePartrtreM of Loml Governmenl fl�nc
INSTRUCTIONS: .JUL 5 2012
To be fifed in person or by mail with fhe County Auditw or Counry Recorder o! Ne o�ur(ty perty is located.
Fii'mg Dates: i) Real Pmperty. Must file dunrg the year (or vrhich the tleducfion is so ht.
�9
2J Mo6ile /Manufactured Homes �rot assessed as Real Pmperfy Must file d�nng � (12) monfhs
beforeMarch3fofexhyearthedeductbnissought. GIBSONCOUNTYAUDITOR
See reverse side for addi[ional instroctions and quali�cafions.
Apacant (owriera�crntrad buyer - see rgstrfcn�eys m 2veise sitle) ��
�'�,
no, what ¢ his / Mr ezact share oi interest?
It n211�C M RWfd 6 d11fEYalt C�311 Cidt O( e�IP5f2fIL o�tliral2 E2bN!
Nartre o( rnorigagee ar mnNacf
File Mark
Fam mea wnn:
�County Auditor
❑ County Recorder
-lop�o3�-��S �� � P�(��
nCebtedness unpaitl as M Mortgage I Confract uWebteEness unpaid as o( Is Ne appfmant the sde
�y/r� dace of appGCation legal w equitade ovmef?
�,�vU ❑Yes ❑No
S,
ACdress of rtnrtgagee or contrad Se�M (nurMr� entl sbeeL �: s1affi. M Z
��r: I/n, ,—.--� I ��i-�
f� R.l,l � �.
neeRSS o � �G �.�,2
murrtyaindlr I a � � � �O
tlion app�oveC c� Ne amount ot.
20 20 20
1 I We
somearre other Ihan sPOUSe. indicate wM Mmm
What Tadig Districl7
20 I 20
151M P�PertY in VuestiOn: MnuaP/ ASSeSSetl
❑ Real PmPe�1Y ❑ ��Y �
Modle Hort�e QC G1.
I��
rn poperty
❑ No
�
under the penalry of �Serjury that the aboy� and foregoing infortnalion is we and cortect and Nat the applirant is a resident of I�iana and
act buyer of the aforemenlioned propert)f'on date application is fiied.
Slutl na e) Date (rrionN, day, ysa�
ess ot appf n nu bar a dry, te, aM ZIP e) ffr���,,,
/ /
I
i by dW/ ex Power o(AtlOrney or by IC 61.1-72-0.7 �ate (month, tlay, yea�
Atldress ot auNOr'aed person (number aM sbcet �: sbfe. and ZIP code)