HomeMy WebLinkAboutMortgage_Koelling"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u p vear
__, s FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm C3709 (R11 / 6-09)
S � Presai6ed by DePa�M of Loral GoremmeM Firence
�r.
File Mark
�wsrRUCnorvs: c.�.
To 6e filed in person or by mail with fhe CountyAuditor or Counry Recorder of the counry where the pmperty is focated. �� ���
Filirg Da[es: 7) Real Property: Must file dufig the year /or which !he deduction is sought. ' (,�1A� UN Y A IT�nry Audimr
2) Mo6Ae / Manufectu2d Homes not assessed as Real Property: MuSf fJe during the fwerve7rq� ITi�
before March 31 0! each year the deduction is sought. Counry Recorder
See reverse side for additional inshuctions and qualifications.
ty orstta
� �
Assessetl vakie d real popvty az ot
Ma�rh 7. aa�mi year
H ro, what a his / Mr exaa share ot u
If rwne m remG "s NMemnt Ihan Na
Name or nnrtgagee w mntract se0er
Address d morlgagce ar mntract se0
r�� or �re «ome� �� � r
AtlCress ot assgnee (num6er aM a!n
i�er / legal d
-7 n_
mdipte �ebw.
sbeel �Y. �Le.
slete, and ZIP code)
Jimnt own pfoperry in any aher I If yes, wFat munty.+
Indana?
❑ Yes ❑ No
Deduction app�oveC m Ne amoun
20 20
Signaene w Camb niditor
20
Rem`rti number
_ p L�
EOness unpaiA az o( IMgage I ConVaC intlebtedness unpaitl as M I
data o( eppfxatim 1
��
H owneE wiM sameore dher than spasse. indrcate wifh wha
Pege numDer�
ti�
PP�^t Me Sde
equilable ameR
] Yes ❑ No
Is iM property in question: MnuaOy Assesti.d
�Steal RoPertY ❑ Mrnial�'. Hsses?ed
�A2� ° ILoE ��
N � �`• �' L �P�Y
- � �_y�53� ❑ "°
20 _ i zo _ � 20
Da�e (moNh. daY. Y��
20 _
I/ We certify under ihe penalry of perjury that Ihe above aM foregdng intormatlon i5 We and CorreCl arW �hat Ihe applkant is a lesident of IMiana and
owner I contracl buyer of the ataementioned property on date applicalion is filed.
Sigreture(ownefslu0name) _ Date(rtnvN4daY.Y�h
Fu0 rrsiEent a0dre55
n
and ZfP oode)
Power of AM1Ortiey w by IC 61.742-07
Pddress o( authoraed persm (wmber aiM stree; dry, slafe,