HomeMy WebLinkAboutMortgage_Kaucher�,�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Co , Township Year
�J • State Fwm 43709 (R6 / 5-06)
� Presvibed by Departmenl of �ocal Gwemmen� Finance
�NSrRUCrioNS: FEB � 7 ;;���
File MarK
To be filed in person or by mail with lhe County Auditor o/ the county where the property is located. �,, �.
Filing Dates: 1J Real Property: During the 12 months before June Il of the year the deduction is to b�� ect ve�
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the ye��@�A�6lpqrpQ� �� eflective.
OR
See reverse srde for additional instructions and qual�cations.
Applica t(owner or contrac� yer - see resMctions on reverse side)
�
Taxing Dislrid Key number / legal description Record number �
�� � a b-�--� -09 -aoo -ooy •013-f?� � Page number � �O
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
' I 1 O l�J ,
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
eal Property ❑ Mobile Home pC 61.1-�
��e of mortgagee or contr seller ,
Address of mortgagee or contrect seller (num d street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code) DCB��'eC l�i�..�. �.......
Dces applipnt own property in any other If yes, what county? What Taxing C Ca I'(� �� .... �.� �....... d on
county in Indiana? �`' 1 p/_�l �� � No
� ptDo(
COUNTY AUDITOR
Dedudion approved in the amounl of:
20 0 20� 20 20 20 20 20
�
Signature Counry Auditor Date
`Ne certify under the penalty of perjury that the above and foregoing iniormation is true and corred and that the applicants was ! were
sidenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (ownersQ(ull name) Person authorized by duly executed Power of Attomey
x 4m� /�ar°n �GLtC�r or by IC 6-1.1-12-.07
Full resident address ot applicanl Address of aulhorized person
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