HomeMy WebLinkAboutMortgage_Kohlmeier� rt�3
��STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION u To i Year
� Stale Fortn 43709 (R6 / 5-06)
�� Presrnbed by Deparimem of Local Govemment Finance
�
�
INSTRUCTIONS: � File tvJ,a�
To be filed in person or by mail with the County Audito� of the county where the property is located. ���f ��•
Filing Dates: 1) Real Propeity: During the 12 months before ,lune �l o/ the year lhe deduction is to be etlect'v . ol1NTY pUDITOR
2J Mobiie Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the ye����uc6on is to be eflective.
See reverse side fo� additional instructions and qual�cations.
Applicant (o orcontract buyer
��l?i � /
`�Q�.� f
Assessed value of real property as of
March 1, curtent year
whaf is his / her exact share of interest?
If name on record is different
of mortgagee or contract seller
Address of moRgagee or contrad selier
on reverse
Key number /
/ --
—V V
Record
-� ,
MoRgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year � gs� � ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicale with whom.
indicate below:
street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
Signature
Is lhe property in queslion:
❑ Real Property ❑ Mobile Home pC 61.
��':l {VC'1' r
_ ���..Q%_.
C:1C(� �\*�.
What Taxing Distrid?
COUNTY AUDITOR
20 �� 20 �� 20 20
P P
n ( ,a County Audilor
•F.a„ �'
Has this deduclion been requested on
property for current yea(? � Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 7, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person