HomeMy WebLinkAboutMortgage_Koch (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
___ FOR DEDUCTION FROM ASSESSED VALUATION
Stdte Fafm 037W (R71 / fi09)
1 w. Presm�etl M DePartrneru W Local GoremmerC Fuunte
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To be fiied in person a by mail with the CounryAuditor or Counry Recorder of the oounry whele the pioperty is located. A�j �O L� �
Fitirg Dates: 1 J Real Pmperty: Must file durrrg Ne year /or which the deUUCL'on is sough[ � County Auditw
2) Mob�7e / Manufacfuied Homes rat assessed as Real Pmperty Must file dunng the hveNe (72J months ❑
6efore Mardr 37 o(each year the deduction is sayhG � nry Recordu
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Sea reverse side for addr(nonal instructions arid qualfications.
AppGc3Wlowner wmnhaC 6uyar - seq resqt0ons m reverse siee) GIBS
Ta�dnq i' ' Key number I legal desai0tion Remrd number Page wmbrl
- l-d7 -�{00 —00� / 7�- p d 7 �fl/D 07l�
Ass�ed vap�e of mal O�P�Y az of Alort8a9e / Contraa 4debteCnass unPab az W Mwt9a9e / Contra`Y mCebtedness �mpaid as d La t�e ePP�� tM sde
Mercl� 7. Mmt Yesr Mafth 1, artPnt Y� dete o( aGP��^ � a�^� �
O O O ❑ Y� ❑ No
I( m. what's his / Mr e�o share af interest? K owned wiN somewre other ihan spouu. md�te WN whom
If nartre m recad'a NRerent Wn that of aDP��t trWirate beb�r. Is the ProPenY in Gues6on: MnuaN' Assessed
❑ Real P(oPertY Q A"m!all�'. P� .._
Narte of rtartgagea or mnvaft seller '
l�
Add�ess of nnrn�a9ex ar mntrad se9er (n�n
Name of assignee a oMU owner or halder �
PdCress of av9gnee (r.0 r ard stre`e; tll
� J�
Ooes ePpticant wm prapeM1y in any oNer
munry u� IMiana? �
❑ Yes
DeducGOn app'o�ed in Ihe amount of:
20 _ 20 _
Sigrehire W County A�tlimr
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I/ 1�l _rtify un Ne penatty W q
rowner I c ntracY buyer of the �f
Sig�ani2 (oq efs hA reme) i
� and strae; cAy, smte. aM LP
rtprtpage
If yes.
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.S. ,SoB.S /��
What Tarirg Distr'xY? Has N'¢ dedumon Emn requested m p�opnty
. torcwremvea/?- - r, --. - -°-
couNnauoROr Dra�ti�er \'Q,�, O/ o
zo Card NO. ..,,3.(�..�.i?
Counry •••
I ' _
the above arW foregoing information is We end mrtect arW Nat ihe applicant is a resident of Irdiaria and
property on date appli�ation is filed.
Date (npntl�. OaY. Y��)
pllont (number aM/p��e t, a7y, slate, and ZlPCOtle)
30a S_ i�. ✓GCT'-� � N
¢xerytetl pawer Attpney or by IC 61.1-12-0.7
P4d�s o( au4�n'ved prlson (numberaM sveeL �Y, s��.
6 7�
Date (monN, deY.