HomeMy WebLinkAboutMortgage_KramerSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courn
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 93709 (R71 / 6-09)
�' �.,� � Ptnaibetl M DeV��M of Lacal GovemmeM Firence
INSTRUCTIONS:
b be filed in person oi by mail xiM the CqunlyAuditor or County RemNer oI the oounty whe2 (he poperty is located.
FiNng Dates: 7J Real Proparty: Must file durirg the yrear for which Ne tleduction is soughl.
2) Mo6Be / Manufadumd Hortres rat assessed as Real Prt�perty: Must file d�n/g Ne IweNe (72) monfhs
before Ma�ch 31 of each year the deduction is sought.
See reverse side lor additional inshuctions end qualifmations.
rpr buyer- eere5nceons versesAe)
T �1�"%� K���/laT_ �_�'��-�o�i�=o/''
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.-..T�.�.y-J
tt name m rerntl o 6rtemrt Nan tlat W aPP��t trdka� Eebwc
Name W rtnrtgagee or contrati seDer
Pddress of rtartgagce w mntrad seDer (mun6ar end svee4 ury, stam, anE:
Name of a4ignee a Uhef wmer w Imlder of rtaRgage
�N �u�ry��
Counry Recorder
n�mne.
unpaid as W MMgage / Contraa cdebteMess unpalE as of Is Ne epp6�ant tlro sde
date W aVP��^ kgal v eWilatle wnC.+
/ ❑ Yes ❑ No
M vrned with someane other Nan spouse, indi�te with whom
Is MW�YinQuestim:MnuaDyAssessetl
Real ProPeKY ❑ %��Y �
PdEress o/ astignee (numOer antl sneet �Y. s+ete. antl Z!P cotle) ___ ��—
Opes a�iram ovm pmperty in anY oNer I( yes, what oount�/? W�at Ta Y
munty n tndgna? ❑ yes � aO � O No
❑ r,o Di a��•er \0 ...................
COUNTY AUDRO ati 5 � -�
Detluctions7Wrn'ed'uitlreamountol: C�71�C� �i�. ........... �........
zo zo_ zo_ zo � Ia.0,71y."� .� �—
Sigrianue U Camb Aueitor Counry Data (month. daY. Y�� ,
i/ We certify undel Ne penalty of perjury that Ne above and foregoing infortnalion is We end cortect arW ihat Ne appiiCant is a resident of I`Miana aM
owner / cqptracl buyer of Ne afwemerN�pned property on date appliption is filed.
idant address of appfrani (nuh�Der antl sLee4 tlty, te, a
�. �7 /I� 1 � ; PDa �. tr�c
autM�tretl Gy dNy exew Parer ol Mpney w by IC 6
3 of auttwr¢eA Ge�^ (numbera�N sneteG �: sfate, anE