HomeMy WebLinkAboutMortgage_Kolhouse'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
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� FOR DEDUCTION FROM ASSESSED VALUATION
�• State Form 43709 (R71 / 6-09)
�` � PresviAetl by Departmem of Lowl Government Rrence
�"" Fil
JSTRUCTIONS: F� q� �:
To be filed in person w by mail with fhe CounryAuditor or Counry Recorder o( fhe counry where Ne property is located. V Q 9Q�9
Fil'mg Dates: i) Real Pmperty: Must file during the year for whith the deducGon is soughL �� ICdGnry ktkAbr
2) Mobde / Manufactured Homes rrot assessed as Real Property: Must f+le dunng the fwelve (12) months
6efore March 37 of each yeai the deduclion is swght. ���� �
See reverse side lor addifionel instnictions,and qual�cations.
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a Ke� mt
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Assessed vWue of real aapeM1Y as d
MaU 1, brRrY ymr
�i M. `Aild� 6 �IK � iWJ OYdf� 5�13f0 Oi V1iPJP5��
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�i f13(IIC pl !E`LVfd 6 QIiiCRlll I�13f1 I�12i 0('2p�"c
Nartre or mortgapee « contraU seYer �� �
AdAress of nroRga9re
Name
se➢er
r i ai aesrn
� ,� -do�-�s�9-6a�
Mor�qage/ Contraa intle6tedness unpaid az of Mortgage I Con
Mamh 1, wrtent yeur date of aPP�F
owner or halder ot morte�age
(number aIM sdeef, dly. Sbfe,
Opes apDlifam wm pmperty in any oNer
county in Ind'ena? i-'1 .,_ _
�
20 _ I 20
Sig�aMe d
of
crty,s7ate.
wiM mmea�re
Remrtl numEer Pag numbel
a �a�
�tedness unpaid as d Is Itre appfrant tlia sde
kgal w eWit2ble awnel�
� ❑ Yes ❑ No
' irate witli whom
GS I�IQ pNpCf(y Ifl Q11ES�OfL /�1IfRl3� ilSSPSSCd
❑ Real Pro�' ❑ M^ualh' As�ed
a�ae rio� nc ��.�-
`, ICOLWouse� JoN� /L
yes. whal munt/t What Ta�drg Di /�� a �` O
20 _ � 20
8�, 000`p
�p 2(1 2�
Date (mmth. daY. 5'��
1/ We certify under Ne penalry of perjury that the above and fo2going informalion is true and correct arW that the appli�an[ is a resident of Indiara aM
owner I conVad Duyer of the afwementioned property on date appficatlon is fiied.
..,.n,.d �,,,.�.t im.�wrwl Date (month. daY. Y��
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aW�assed V�".+a+
tlry, state. and
sbte, anALPmde)
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