HomeMy WebLinkAboutMortgage_Kunkel (3)* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n` h Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �
� SFata Form 43709 (Rii / 6-09) �
�' Presaibetl by DePartmeM of Lad GoremmeM Flnance �
wsraucnoNS: ��N '�j �fU
Fortn Ned with:
To be filed in persnn or by mail wiN the CounryAuditor or Counry Recorder of the counry where the pmperty is located.
Fi!"mg Dates: 1 J Real Pmperty: Must file dunng the year fw which the deductlon is soughL `-�yy� ��unry Auditnr
2) Mo6de /ManufaUUred Homes rrot assessed as Real Property: Mus! file dunrq the hvelve (12) months�'!
before March 31 o/each yearthe deduction is sought. ounry Recorder
Seereverseside7oradditionali�eOe�clionsand�ualificali�ns. n � / GIBSON C
MW�nt(ownerorcono-aftb r'see ��TiR(x�id°) /l n , i . _ �/J_ �— �
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H name on i
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Name af as ��� ��
AEaress ot. Vj �
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ooes epp�� _
munry m IMiana? � I"I .,_ _ r
DeCUCtion approvad In Cre amount oY.
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I I W certify u fhe penalry
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nt hM'wate Eebw.
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No
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`�, J/—O /� Rem�E numbr+ � Pa9e nye�bu �
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as N Morigaga I Conttxt "uWebtedness unpaiE aa of Is Ne app8�l the sole
Eate o/ appGration kgal or equilade o�meR
n Yes ❑ No
tt wrtrod wiN wrtieone dhu ihan spause.
is C�e property in QuesUan: Mnuellyl�ssesseC
� Real RoGBKY ❑ %�DY �
Abdle Home (IC 61.
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C71'C�.��rO �_ . SO�C •..,
— '� $0, ck�p 'ap • . .
couNn auorroR
20 _ � 20 _
Counry
Pi5
Oeen requatetl on proprity
20
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the above aM foregt�ing intortnatlon is trve and cortec[ and that the applicant is a resident of IMiana and
property on date application is filed.
: . .� Date (rtm�. daY. Yse�
ve�^ (number aM stree[ �: smte.
J 5�?66
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