HomeMy WebLinkAboutMortgage_Kolley"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � n Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION �
� State Fwm 43709 (R71 / 6-09)
S.w � P�esaiEeG M DePartmeM o( Local Govemnrent Frianca
File ark
INSTRUCTIONS: D E C �
orm t�ed witic
To be filed in person w by mail with the CounryAUdifor or Counry Recorder o1 the counry where the prope�ly is located.
Filing Dates: 1) Real Property. Must file during the year lor which the deduction is sought. �County Auditor
2) Mo6de / ManufaUuied Homes not assessed as Real Property: Must file dunng the twelve (12J months�'%l�
before March 31 o/ each year the deduction is sought. r GCounry Recorder
See raver� side tor additional instnrctions and qualifications. pl�$ON CO '
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IAat[h 1. ac�aR �ear
i� M. W�13I6 �15 � �IC! 8x21i 5�12IB Oi 1
tl�me m iemrd's CiRemn[ Nan tha
Name o1 rtnrtgagee or contrarl seAer
Key rnimCer / legal desaiG/
aG-al-3a-3a3-7oo. Sb 9-00
ge / Conbau intlebtetlness unpaid as W Mortgage / ContrarY i
Ma 1, n�rtent year date W appGCatipi
(�IBSS O�RIOfI[J29PE W mllff8Cl5fOCf
Name ot esviFee or aM,r ormu or MWer m mort9age
Does appli�aM am poperty in any oNer
munry in Ind'ana?
❑ Yes
DeducCOn approved In the amount ot
No
ate bebw
�
�t u�l: sfare, ara i
LP oade)
��
If yrs, what munty.�
zo _ � zo _ � zo
Remd number
O/6
MNness unpalE as o(
sPOUSe. udifafe with xim
Yes L� No
e property in auesbon: Mnua�Y Asusse0
Real RoPenY � �^^��Y �
� �� � �
What Taang Distriri? Has Na deduction
for aurmt yea(.+
� D�nY
❑ No
"' _ _
�y�4i�la.tc'ow.9 6c�n�L
zo_ Dra�t�er \O...G��1���...... 20—
,�n,� w� cam hnw�« n 1 I�r pO i
� w.a— ✓�, ,L� C3CC� �j�i�. .. �.Q..�........
i/ We� the penalty of perju Mat ihe above and foregoing intc �� �i �Se l� or i�a�� a�a
owner I mntrad buyer ot the aforementioned property an date application is filed.
� I Sgretire
aMStrecf,
� S,
by IC G7.1-12-0]
person (number arM saee; ci(y, state.
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