HomeMy WebLinkAboutMortgage_Kueber^^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou 7ovmship vear
• FOR DEDUCTION FROM ASSESSED VALUATION
• � State Fwm 43708 (R71 / 609)
S i p�y�p¢p by �epartment of Local Govemment Friarwe
File Mark
INSTRl1CT10NS:
e wl
To be filed in person w 6y mail with the CounryAUditor or County Recorder o/ the couniy where the property is located.
F�Tuy Dates: 1) Real Property. Must fite during the year Por which the deduction is sought .'�. f�Aud'rtw
2) Mobi7e / Manu(actufed Homes rrot assessed es Real Property: Must file dunng the hveNe (12J months ❑��
bePore March 31 of each year the deduction is sought o Recorder
GIBSO
See reverse side /or addrfional instrucGons and qualifications. - OR
ApDGranl (oxireror contraC 6uyer - see r�strjctiwu an revarse side)
�
—LI' L'
I rahie oF real popeny as d Mo ge/ Contrac[ u
nmen[ Year Ma�1. artenl year
11 ro. whaf Is his I her eurs share Of interest?
tt name m remd b drttemnt Nan ihat o/ aPP�t hid'c
Name ot rtwrtga5ee «mnvaa/ _�
Address of rtart9agce ot mntrad uuer (num6er and sv
Name ol assigr�ee w oNnr owner or twldu of morigage
ACtlresS of assgnee (numbuentl slreeL dry, stete, and
Does ep0��,nt own property in any olher
counryinlndw�a? � No
Yes
prau�roon appro�md In ihe artwuni of:
20 _ � 20
set, N}; stata, aMLPa#e)
Z/P mCe)
Ii yes, what muntyl
Recrnd numbpl Page numb •u
1 �-Da o
a N Moripage I Conval'vWe6tedness unpaid as ol Ls Ne aPO�t the sde
date of appOtatbn �egal or eqWtaWe ox+iel+
❑ Yes ❑ No
If awned wi;h someane dhel ihan sPrnae�
Is tice D�P�Y in Guest»r� Mnua%ASSesved
❑ Real Provertv ❑ amuany asseuea
� 1��,.�0 �T. a°
Drawer \'O.l.�'1,.1�..a�.�.':.....
card ���o. ...�� i1s ....
20 � 20 _ � 20
Counry
20 _ 20
Date (moNh, day, yea�
�,
❑ No
i/ We cerVfy undu Ne penatty oi pe�ury that the above and foregoing intormatirn is we and correct and ihat the applicant is a resident of Indana aM
owner I mntract buyer of the aforementioned property on date appfication is filed.
address d
,?S<
5ate,
61 A-12-0.7
au4waed persm (num6erand sbeet, ciry, s�ate.
/l�, �Z'N y�GC..� -
o�e c,�,a+u�, aar. r�a