HomeMy WebLinkAboutMortgage_Kolb (4)"•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou s' vear
__, ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 6O9)
�' ,�,� f P25aibetl by DepartmeN of Loml GovemmeN Fu�atxe
NOV 2 8��0�
wsrRUCnoNS:
F� mea wan:
To 6e filed in person or by mail witli Ure County Auditor or Counry Recorder of the oounry where the pmperty is located.�, _
Filing Dates: 1) Real Pmperty: Must file durirrg the year lor which the deduction is sough(. �( �unry Auditor
2J Mobile /Manufactured Homes rwt assessed as Real Pmperty: Must Ae dunng the fweHe (72) mon� n C.ru
beforeMarch3fofeachyearthedeductionissought. pIB�dNCO NT1=-/1U�n�p(Recorde`
See reverse side for addrtionaf insWCtions and qualilcations.
Apo6pnt(ownerorpon 6vyxr-s9eresL'coonsorneverseside �
II real p�opelty as
Y�
ro,
,-L„
;��u
wrtentyear
If name m rew�tl is dAferent Nan Nat ol appti�ant, indifate Eeb�r
Name ot rtwrtgagee or con seller
� nl ,�
Address W nwrtgagee or contraG se0er (number ai
Name of assignee or ahel owner or hdder of mory
Address of assignee (number aM strea; dry, sfete
Does epplinnt own praperty in eny oNer
munry m Ind'ana?
❑ Yes ❑ No
Detluction app�oved in Ne amount of-
20
Signature N Counb Auaitor
ee4 �y. s+ate. alM �
ZIP cotle)
Ir yes, what couny+
20 - � 20
Remrtl numbu Page numCnf
� . -o ao� 6
unpaid as of Mrxtgage / �ntraa inde6tedness unpaid as d Is Ne appOrant Me sde
data of applicatim Mgal w eputtaWe ame(.+
❑ Yes ❑ No
If o�med vriM someone oiher �han spouse, ifMi�ate wRh wtwm
Is ihe property in puestion: MnuaM Asessed
❑ Rea� amvertv ❑ ArmuaMAssessed . . _
Dra1ti•cr NO.�.�.�.....
wna�r�n C:I1'C� �`�. ..�a2 � � ,—
....... m
20 � 20 _ � 20 � 20
1/ We certify under the penalty of pe�ury that Ne above arW foregoing infortnalion is We and corred and Nat ihe applinnt is a resident of Indiana aM
owner 1 mntract buyer of the aforemerrtioned property on date appliption is filed.
maNreMwners MI namel ,. A I Date (monfh, day, yea�
Fu0
Person autlrotaed �y
ciry, slate, arad
persan (number arM sbee; cify, state, an0 LP code)
�
�1�(o7U
Date (monN, tlaY• YEa�)