HomeMy WebLinkAboutMortgage_Kohlmeyer�,....�
e�` t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
eP�'" : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�•.�__� y• S�ate Pofm 43709 (R4 ! 10.01)
� Prescnbe0 by Oepanment of local Government Finance
1NSTRUCTIONS: � �le ark
To be filed in person or by mail with the CountyAuditorol the counfy where fhe property is lo d. ��-�-�
Filing Dates: i) Real Property: Dunng the 12 months betore May 77 0! lhe year !he deduction is to l��(�((ec iv .��nL
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma�ch 31 oI th���}+�ilr t eWtltpn is to be eNective.
See reverse side /oradditronal instructions and qualificalions. /'` .. n
�r+ppucam �otvner or con(ract buyer - see restnctions on reverse side)
m T ' a e
Taxing Distrid Key number / legal description
, ,
,
�e��-e r l o w�, s h; ooz -ap�3S� 00
Assessed vaiue of real property as of Morfgage / Contracl indebtedness unp
March 1, wrrent year March 1, current year
�
�
' 1I
If no, what is his ! her exact share of interest?
Kecora number
�L
Page number
as of Is the applicar
owner?
t the e �egal or equitat
es ❑ No
6�1� . �
�If owned with someone other than spouse, indicate with w m.
�G-/a-a�-�aa-�Qa. 3s�- ���
If name on record is different than that of applicant, indicate below:
of moAgagee or coniraG seller
Address ot mo t�ge
21 S,�
Name of assignee or
Address of assignee
contrect
owner or
(number and street, city, state, ZIP
mortgage
and street, city, slate,
Does applicant own property in any other I( yes, what county?
county in Indiana?
Deduction approved in the amouni of:
20 20�_
/ �
Signature
s ihe property in question:
❑ Real Property ❑ Mobile Home QC 61.1
�J' �J�J
Taxing Disirict? Has lhis deduction been requested or
- property for current year7 �] Yes� N
COUNTY AUDITOR
�12�'�
�
_ County Auditor
20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
la resident of Indiana and owner o( the atoremenlioned property on March 1, 20
(owners full name)
� P.e/ ��Y/�CG
:nt address of aooli�
Person authorized by duty executed Power of Aftomey
or by IC 6-1.1-12-.07
ot authonzed person