HomeMy WebLinkAboutMortgage_Klusmeier"'� STATEMENT OF MORTGAGE OR CON� I�d��� Coun Township Year
_ , FOR DEDUCTION FROM ASSESSED VAL T{�
State Fotm 43709 (R71 / 6-09) g
�•S w. � PresaiEetl by OePaRmeM o( Loral Govemrtrent Frence
wsrRUCnorvs:
DEC 2 9 2011 File Mark
To 6e fiied in rson w b mail with fhe Coun Audito` or Coun Recorder o/ the ca F�" ��'m:
ce r b h v�aenr;s�o�rea.
Fi7irg Dates: 1) Real Pmperry: Must file tlum�g the year Ior which the deduction is`soughG \ Coun Auditor
2) MobAe / Manufactured Homes not auessed as Real Property: Must fi/e dunng e}w�e (12) months ry
6e(ae Ma�ch 31 ot each year the deduction is sought. � Counry Recordu
GIBSON COUNTY AUDITOR
See Ieverse side for additRnal insnuclions and qualifica(bns.
nppficant (owner a , vy�r�ycee restric8ons �i se side)
' 0' " „� � n/ l �•/�p��e921 dl 1° � a- a d3 - o00 .� 4-oa a ReoD�d num0er Page twmber
�;� ��;� �, av� � � ad
Asussed rahie cf real Mo�rtY az d hbrtgage / Contrad inde6tedness unpaid az W Mortgage I Can�'uNeMedness un7aid as d Is Ne aPP�t Ne sde
Marh t. qrernt yrar March 7, ai�yp� Oate ot appfxation Iegal � e wmeR
lJ ❑ No
If rw, what is his / her er.aa share o/ intervst? If owned with someone aher �han spouse, irMifate wilh whom
If name m remtl a 6Rerent Ihan Nat af aGP���• u�Exate bebw: I5 Me OroPenY in 9ue56m: MnuaOy Ats¢sed
�Real ProPertY ❑ ArmuallyAssessed
Name of rmtgagee or mno-aY seDer � J� �n/� �
\I 1, � � (
�� :-
Mdress o( mort9agee or cmtract seller (num6er and stree4 cey, sfale, aM
Name at assi�ee w oMer owner or halder of rtprtgage
AOdress ot assgnee (number aM s1reeL mi; slate, aM ZlP code)
Dces applipnt own peoperty in any oNer If yes. whal munry
tounry in IrMana?
❑ Yes ❑ No
Deducoon approved "m t�e amount of:
20 � 20 � 20
� — - US/nt�L
� �t�z�E � � �����
un,a �P �L� /-�"' �
Z i, ��oo ��9 a� � ,�
/
COUNTY AUDf
I/ We certify undu the penalry of perjury Nat 1�e above and fo�
owner I mntracl 6uyer of Ihe aforementbned property on date pp c
��SignaWre (owne/s fidl neme) ^//1 '^� D/.7nr� �
V�J `%i�^'��11 �
WI resident d applrcanl (rv�mDera sbee4 �Y. �te. and ZIP cotle.L
l0 3 07�`Q/��v� (��rD-riQ.lrc.
�Urorrzed Gy duly ezecure0 Power of Attorney or by IC G1.1-12-0.7
Pddmss o( aWwmsd person (number amd streeG dry. slafe. and LP code)
�Y
20 _ 20 20 20
Counry Date (nbnth. eaY Y��
�infortnation is true anC cortect antl Ihat ihe applinnt is a resident of IrMiana aM
ation is filed.
Date (monN. day, yea�