HomeMy WebLinkAboutMortgage_Kolb (2)S _. rt• ,�
��.
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slaie Fofm 43709 (R4/ 10.01)
PrescribeG by Department of Local Govemmeni Finance
Coun Township Year
� � �
"wsrRUCnoNS: APR �ey��Q02
To 6e filed in person or by mail with the County Auditor of the county where the property is located. �
Filing Dates: i) Real Property: During the 12 months before May 11 0l the year the deduction is to b e ctiv . �� /J�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l t- eg�� ��� �. .- ro-tr�< t�ve.
FUDiTOR I
See reverse side /or additional instructions and qualifications.
Applicant (owne�orcontract b er- see restrictions oprevers� �"de) �� ���". /
/ �1 `CT l I% ir�'^�d-
Taxing Distrid Key number / le �tion Record number Q�
� p� _ - _ Page number 3 a gs �
V
Assessed value of real property as of Mortgage / Contract indebtedne s unpaid as of Is the applicant the sole legal or equitable
March i, curtent year March 1, current year ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? 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:
❑ Real Property ❑ Mobile Hane (IC Cr1.1-�
e of mortgagee or contraci ler ��
�
Address of mortgagee or contra eller (numlier and s t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yeaf?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �� -' zo �_ zo �0 2o Zo zo zo �$_ o
R �y �.r3.P ��ao�- `Q P �P P
Signa re County Auditor Date
' We certify under the penalry of perjury that the above and foregoing intormation is true and corred and that the applicants was / were
esideni ot indiana and owner of the aforemenlioned property on March 1, 20
Signa re (ownet's lull name) Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07 � �
Full re ident address of applicant Address oi authorized person
� ��