HomeMy WebLinkAboutMortgage_Kennard (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
s FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn d3709 (R11 / 6-09)
i 1 Presaibea �y �epartmenl af tnral Govemment Fnance
INS7RUCT10NS:
To 6e filed in person or by mail with the CountyAUditw or Counry RecoNer o/ the caunty where the properry is bcated.
Filirg Dates: 1) Real Pmperty Must file durirrg the year /or which the deduction is sought.
2) Mo6Be / Manufactumd hbmes nnt assessed as Real Prt>peRy Must file dunng the lweNe (12J months
6efore March 31 of each year the deduction rs s�xght.
See reverse side (or addifional instructions arnl0ualficafion5.
Co�Auditor
�ounri Recorder
�istrirl • KW 6er! legal drsrn Ren numDer P e niunEu
�-� -o -�Gy-�oa. �.sa -�.z� �oio ��
std rdh�e d maI P�nY at af ge / Cantra� indebtedness unpaid es d Martgage I Contraa mdebtednrss imG� es d Is Me eG�t the sole
i 7. anW Kar 1. artent year Oate of appGCatim legal or epurtade o�wYl
Q ❑ Yes ❑ No
xiut is his / hu e�od shafe of inN.rasl? 1/ owned with someo� oNer than sWuse. trMitate wlih whom
�e m recoN is QAturnt tAan �hat of aDP� c�tlipte below is Me P�7�Y in Ouestion: Mmie➢Y Pssessed
.^ n ❑ Real Property � bbbile Fb��(IC d61.1-�
Narre of mMBa9re m mntran se0er
.� J p
ACdrass of rtart9a9� or mntracl seAer (numbe� arM s0
Nar�pf atsqpea or ot� L gr rn� er o( mortgage
i / / J
L��� �i i b
P4tlres oi atignce (number and atree4 mY. sbfe. end
cdy, state. aM
dkant ov.n p(operty in any o�her I If yes, what munyl
i�a�na?
❑ Yes ❑ No
petlupion apyoved in ihe amount
Tadn
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a�� C, \O �
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C�`�\�•''� 0��,�
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20_ 20_ 20_ 20_ 2�_ 20_ 20_
s�reaae d co�,b nwnnr co��cr oa�e (�anm. ear reed
1/ We certify uMer the penalty of perjury that the a6ove and (omgoing infwmation is We and cortecl and that the applirant is a resident of IrWiana aM
owner % mntract buyer of the aforemerrtoned properry on date application is fiied.
FuA �esidem am`cs a apprrant (numEe� ana strceS aN. ��e, ano z�r aoee) .
� SO � M.��2'q � E E U� 2 I fl FJ l',e i �,/c E�'Y�.� ; ���L JC�
Pelwn autMi@etl by duty exewtetl Power af Aimrt�ey m by IC 67.1-12-0.7
PdEmss of au4araM person (numbrl aM sbae; crry, state, anC LPmde) _
oate (rtwnui. tla}:
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