HomeMy WebLinkAboutMortgage_Kolb (3)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
__, a FOR DEDUCTION FROM ASSESSED VALUATI� ���
.� State Form 43709 (R71 / 6-09) .
��` l Presaibed by Departmenl af Loral Govemment Rnance .
'°' File Mark
INSTRUCTIONS:
1III Form t�ed with:
To 6e filed in person w by maii with the CountyAuditof or Counry Recorder o� the oounry �dklt t� � � located.
Fd"mg Dates: 1) Real Pmperty: Must file during the year lor which the deduction is wughG �Counry Auditor
2) Mobde / Manufactured Homes not assessed as Real Property: Must file d@irip.tii��{f2) mOnths �unry Remrder
before March 3t o/ each year the deducfion is saght. v v
See reverse side foradditional instructions ard qualrfications. i N COUNTY AUDITOR
MP�nt(ownerorcontra uyer-�restrictio�nsmreverge ide)' � .^�i %I.. `��
Mach 1, anelrt'pr
�( Iq, W�Id� 5 �115 ��Ifl
1f `ame on mmN is �
r/�9U}J "� �LV`LV�- I'o�7'Z`�o�-] . laecom
Mortpage / Contraa iMebtetlness unpaid az of Mortgaqe / Cantraa uWe6teCness unpaiE
Maich7.wrt�ut�,ai �., aeteotspprptim
ezatl shara of interesCl
iRemnt than ihat al appacant
r mntrarl seller
of mortga9ce w conbad seAer (number end streel, city, stale. ard
Name of assignee ar o�er rnmer or ndaer rn monga9e
Atldfess of assgnee (numbri eM streeG ciN. state, aM Z/P code)
Ooes epplinnt am WopeM1y in any oNer If yes, what counq/t
; nryinln0iana? ❑ Y� ❑ No
D�uc�on approved i� Ne amount of.
20 � 20 � 20 _ � 20
If wmed wiN someone other ttian spouse,
�'3 �?�
F Is Ne appl'�nt Ue sole
legal w equRaNe owneR
❑ Yes ❑ No
wtnm
Is ihe P��7enY m Guestion: MnuaM Assessed
� Real PtoPeKY ❑ !?^�!�,�,Y,�
- �Q.�> �..� ' - -
\l
�� �oI h � ��������
❑ YPS ❑ I
– J � � —
a.o�a-� g � _
�Y. Y��
2�
I I We certify under �he penalry of perjury that Ne above and foregoing infortnalion is We and correcl aM �hat the applirant is a resident of Indiaria aM
owner I contrad buyer of the aforementioneA property an date application is filed.
. . _. _ _ � �.. _"_", Dale (montb. daY. Ysa�
autlro�d
o(Aitornay or by
ApCress of aulhor'aed perswi (�umber a� strcet, dry, slate, antl ZIP mde)
Date (monlh,