HomeMy WebLinkAboutMortgage_Kruse""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�. FOR DEDUCTION FROM ASSESSED VALUATION '
Slale Fartn 43709 (R10/17-08)
� .. � Presaibed by Depa�bnent of Lor� GwemmeM F'vante
INSTRUCTIONS: . F a
To be filed in person a 6y mad witlr Ne CountyAWifw d fhe county where the poperty is located.
Rli�g Dates: 1J Real Property: Mus! Re during Ne yenr (or wAich fhe deduclFOn is soughf. 1IIA' n/�p
2) Mobde / Manulaclured Homes nU assessed as Real Prtperty: Must file dunrg fhe tweNe (12J MBritfi� �/ae ��iil31 a7 earh yaar
the deducfion is soughL
See reverae side (ar atlditronal insWdims and qualifica Wns
' ., �,r�—�
APG��rn ro,q�eru mnGact E„w- spey¢ibid;ons m,owrse side)
1,Lf'. J _)�l�.Ci�/_�/_
t , ,�• f ' �i", I.i�S
.
SIGf.'�I�
wrtaM year
u�
O as of M«tgapa /
date of applx
I( owned with sameone
GIBSON
az
Is eG�W�MinGUesiim:Mm�
Real Property ❑ Mnua
Mo6ile
Name d mortgagee ar conirad selkr ;�/ �// � ' �-
d mort9agee a cart2d seBer (ramDe�a^fsf�ot aY• s6le. and
Narne d assig(ree or oNer owner u hoWer d mortgape
Address d�ignea (rwrtibriad sSceL �Y• s6�. and LP oode) /'�q
Does aPqkant am popeM in a*/ o�her tt yes, wfut m�rtlyl N �,� 0 O`-f'
couMy m IMaruT -
❑ Yes [I.w�
— VTY AUI
Deducl'an aVGron . . � O �� • • • • •
�lll:l\\'Cl' \�• �
� a�ato........ — �
� C:ll � �O• ... . �
�������A � �ao��o. �� �^
I/ We certi(y unde ._ �.� �u� me above and foregang mfortnation i . �
owner / mnhrdrt buyer of the aforem�tbned property on date applintion is filed.
Signatura (�o/wji�rl�s RA �me)/
l�i�li/1� 3� . �l/11!!1J/
_..____________ _.' _ ...___ ____. ,.
- .3/5 ..�la.�-vw .t?�_ �okv �- �'YG7o
PerSOn a W�oi'sed by d�dy exealad PowBr dAOwriay or by IC 61.1-12-0.7 ,
Addressdautharizedparsan (mmDOrandsbeat,tiry,sbfo,andLPmdo)
rant Ow sale
Mable a�vnBR
Yes ❑ Na
61.
m baen repuestea on O�OeM
i
❑ Yes ❑ N�
_ Z�_
iN. day.Y��
a 2sident of Indiara and
Data (rtmN. dry. Yrarl