HomeMy WebLinkAboutMortgage_Kunkel^�� STATEMENT OF MORTGAGE OR
_ . ; FOR DEDUCTION FROM ASSES:
State Fwm 43709IR71 / 6O9)
S t Prestribed by Depariment of Lxal Govemmerit Frenc_
,� JUN 6 2�11
INSTRUC770NS:
To be filed in person w by mail wifh the CounryAuditw or Counry RecoNer o! the coupiy rty is located.
Filirg Dates: 1) Real Properry: Mus! file dunng fhe yearlor which Ne deduclion is saYyh .
2) Mobile / Manufactured Homes nof assessed as Real Pioperly Must file dunng the 'q onths
betoreMarch3lo/eachyearthedeductionissought. GIBSONCOUNTYAUDTO�
See reverse siAe Ior additronal inshuctions and qualifications. n
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TaA�B 9�si�'i /_ �� �
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t, dnplrt year
ro, what's his / her e� sha�e o( interest?
rwne m�eond'a C'iRerent ihan Ihaf d a0W
File Mark
Form filed with:
Counry Audiwr
❑ County Remrder
- O� �i� �7a39
/ Contrad iMe6tedneu unpaitl as of Mgage / Con "uWe6tedness unpaid as d Is Ne appl&an� Ne sde
vrtentyear date0(aGP�� IegalweWitadeowfM
� / ❑ Yes ❑ No
It mwrred vriN someane otlrer than spouse. mdica2e wiUi whom
hebw. I tt�e ProD�Y m Ouestion: Mm�aDy Assesutl
�a� ProPertY ❑ Nmual�Y As�ed .
Name ai mortgagee w conVaa seller � 1�
lJ
PddresS W nwrtgagee or contrad se0er (number and stme( ray. sfate. aM ZIP code)
name o� assss�ee w amer ovmer ar nmer rn rtioru
AdCress of assignea (numDer aib stree4 �y. slate,
Does e�imfn ovm poperty in any ofher
munrymindiana? ❑ Ye5
❑ No
Deducfirn appwed in Ihe amount of:
If yes. whal munt�R
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�mpeity
❑ No
20 20 _ 20 20 _ 20 _ ZO _ 20
SignaWre of Co�mb AW ifw Counry Date (rtpn�h. day, Yea�
I/ We ceN(y under the penalry of perjury Mat the above and (oregoing infwmalion is We and correct and that the applinnt is a resident of IMiana aM
awner I contract buyer of the aforementioned perty on date appiication is filed.
sigrew.e,jo.yPers n,n na,ne) _. oate (monm. ear. r�n
Fu0
Pasan aWro�¢eE M G�iy ezeated Power W AttorneY w M IC 61.1-12�.7 I Date (nron�h. EaY• lQa�)
Pddress of auNa'ved person (numbere�M sbee4 ary. sbfe, and ZlPmde) .
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