HomeMy WebLinkAboutMortgage_Kammerer"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fvrm 43709IR71/6-09)
� y�. 1 Presvibed by OepartmeM of Loral GovemmeM FillafKe
INSTRUCTIONS:
To be filed in person w 6y mail with the County Auditor or Counry Recn,der o/ the county where the property is located.
Filfig Dafes: 1) Real Property: Must file durrrg the year hr which the tleduction is sough(.
2) Mo6ile / Manufactmed Homes rrot assessed as Real Properry: Must file dunng the RveNe (12) months
6e/ore March 37 af each year the deduction is saght.
Sae reverse side !or edditional insLuctions arM quali�cations_
r_i
IAppGtant (own��e/ip' confraC buyer- see restnr�ons m reversey`-d(e )
'� 1\ C�c �nt lYVL_1LSl 4 f.7 . \u ..�w � 1 f�
I rffiie ot mal propPriy
airentyrar
what a h's! her exarl share ol inirlest?
' � ^
Mor�qage/ Contrart intle6letlnnss unpaitl as
Mart�h 1. wrrent yeer
4 �I '1 r�T r
If name on remN is CMeren[ Nan Ihat of aPp6canl, indinte Cebw
m m«ryay�
hdder M mortgage
p`�"�� \O
��V. \
�a��' �.
C�� � �� � �O ' t�
��. � �a0 �
(number aM s12e; ay. slale. antl ZIP cade)
Ooes e�imnt ovm peoperty in any oNer
counry m Ind'ana? � _ _
County AudiWr
FJOO[fN Remrder
RemrC numher
No
�erty in puestim: MnuaDy Asessetl
'roPeKY ❑MnualyPseSSed
Oeen reQueste0 on pioputy
❑ Yes ❑ No
COUNTY AUDITOR
Deduaion appraved in Ure amount of.
20 20 _ 20 20 _ 20 20 _ 20
Signature d CoumY Auertor Counry Date (month. daY Y��
I/ We certify urWer ihe penalry of perjury that Ne above arW foregoing infortnalion is We and correct arW ihat ihe appiipnt is a resident of Indiana a�
owner / conhact buyer of ihe aforemenlioned property on date appliption is filed.
SignaWre (oxners hArume) Date (month. daY.Y��^
� L� �
' em adtlress af t(number and shce4 dN, �[e. antl ZIP cotle)
i l o v , o E ysf4 dt � rU y 7�3 9
Puson authoraed Ey duty executetl Power af AttomeY a �Y IC 61.7-12-0.7 Date (manN. day, yea�
Mdr�s ot aufhw'vEd prsson (num6er a�M sbee; cRy, state, antl LP code) .