HomeMy WebLinkAboutMortgage_Kerns (3)"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ � FOR DEDUCTION FROM ASSESSED VALUATIO�
� �• State fartn 93709 (R11 / 6-09) 4�
S,u. PresaiGetl by OeO��rd o1 Loml GwernmeM Firence �
File Mark
INSTRUCTIONS:
To be filed in person w by mail wifh the CountyAuditw or Counry RecoNer o/ the wunty wq re the pmperty is loca . Form Aed wiN:
Filing Dates: i) Real Pmperty: Must file dunng fhe year (or which fha deduction is soughtJ�N (�o �n � County Auditor
2) Mob�7e / ManufaUured Homes rrot assessed as Real Properly: Must file dunng Ifi� MvetYg �12) months
before March 37 0/ each year fhe deduction is sought. C,� � County Recorder
See reverse side (or additronal instrticfions and qualficafions.
�
ro.
6uyer- see restrictions
1-7—/la_ipn rs�,,, ��
Mortc�age / Contraa irde6tedness unpaid as d
Mart3i 7. wrtent year
narna m recud'¢ tlirte�ent Ihan Mat W appGCant trdipte bebw
Name ot nnrcgagee or mno-ap
D/.
Mdress of matgagee w contrad u0er (
Name o( assignee or other owner or hoW
A�tlress of assig�e (number arM stree4
Oces eDW��^� � G�PenY in any oNer
munry in IMiana7
❑ YES
Deduction approveE m ihe amoum ot
20 20 _
Sig�aLUe d Camb Audi�w
numbrr and saee; ciy, stste, aM ZIP code
er M nqrtgage
ciry, slate. and ZIP code)
Ir yes. what couny+
❑ No
— COUI
20 20
couNn.
VJhal Tari�g D'aVict?
20
t indebtedness unpaid az of I Is Me eppikant Ue sale
legal or epuitahle owfc%+
❑ Yes ❑ No
Nan spouu. ind'vate v.iM wMrn
Is Uce P�P�Y in Gurstion: MnuaOY AssesteE
�Real Propetty ❑ AtmuallyAssessed
Has Na tleGUCOm heen reQUested m pmputy
tw curtent yraR ❑ �
❑ Yes
20 � 20
I/ We certiy unEer the penalry of perjury tliat Ihe above aM foregoing infortnation is W e antl cortect anC that Ne applitant is a resident o( Indiana and
owner I contract buyer of ihe a(orementioned property on date applira0on is filed.
SiBnanue (�'�c/s M1+0 rame)
FiA
�7�
/ 12�0 !�
of A,mmeY � M IC 61.142-0]
Pdtlress af aWiaved person (num6e� antl stree4 �y. s+afi.
Date (monN, daY. year)
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o� �,r�ww�. ear. r�