HomeMy WebLinkAboutMortgage_KolbSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, , FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (R71 / 6-09)
��w PresmLed M DepaNnu4 01 Lxal Govemmetd Futarcc
File Mark
INSTRUCTIONS:
To ba filed in person or by mail wiM the CounryAuCitor o� Counry Recader oI Ne counry where the property is located. F
Filhg Dates: 1) Real Property: Must file dunrrg Ne year Po� which Ne deduction is sought � Counry Auditor
2) Mobile /Manulactured Homes rrot assessed as Real Property: Must fiIe dunng the tweAre (12J rtronths
befae March 37 01 each yee� Ne deduction is sought. � 'fle�order
See reverse side for addiliWnal instrtatlons arM qua/ifications. G�BSON COLINT Y A I IHti(1R
r o�a // �y �..�,x. i � a�, v • I � �ecob N,� �` �
Y _ /'� ^ �
Asessed raqie d mal poperty a d AW�p�p e/ Cantraa inde6teE�s unveid as d Mortgage / ContraC uidebteE�ss �mpa's1 a af Is Me e00�t ttre mk
Mard� 1, a+mnt Year Mamh 1,�%�� date of aPp�tion �gal n eWitade ownell
"� 1 / 1 � ❑ Yes ❑ No
no.
nalrre an
mrt�eone oC�er ihan spouse.
h the O�Vert1' in vuesGm: MnuaM Pssessetl
� Reel PloPenY ❑ �^^��Y �
Name of rtnrtgapee «mntrxi se0er
Atldress d mortgagce or mntraG se0er (numbu erd strcet �Y• sfa�, aM LP code)
w dher armer or haltlu M mort9x9e
� i�ulrnbei erW StreeL d1Y. Sfete, BnU
I� B��_M�7 D�DenY in any oNer I IF yes. whal munt�? I 4Ma� Ta�dn9 Oistricl? I(or auren��yea(? �n ❑ YCS� ❑ NO I
❑ Yes ❑ No