HomeMy WebLinkAboutMortgage_Kohlmeyer (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
�_ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Form <3709 (R71 / 6-09)
•�' ,�,. 1 Prewibed �Y �G�ent of Local Gwemment Fi�nre
I f�(
INS7RUCTIONS:
To 6e filed in person or by mad with the CounryAuditor or Counry Recoider of the oounty where the property �edj 1"' ��' m� ��
Filirg Dates: 7J Real Property MUSt fiie during Ne year for which the deduction is mughL � Counry Auditw
2) Mo6de /Manufactured Homes rmt assessed as Real Property: Must fiIe d�ring the Mrelve (12J
6efo�e March 31 0l each year the deduction is sought. �� ❑ Counry Recorder
See reversa side /or additional insVUCGons and qualifications.
M (owrreror mntraC buyrs' see rasbicboru m verse sede)
T' �istriC n Key �wmber / IeBal tlesniPtion Remrtl numhel Page numbel
(J� Y / / � / V V
1 vahre of mal prtpery az W Mpry�ge / ContraG We6teEi
m�entyear Mard�l,artentyenr
Ii ro. what Is Ns / trer erxt stwe ot interest?
If name m 2mrtl is dMemnt Nan �hat of appfpan; trMinte bebw.
Name o( rtnrtgagee a contraG se9er �/�
Pddres of nnrt9agee u contract se0er (nturi6e� a svee(�
Name of assignee w oNU ovmer or hddu of martgage
AEEm�s _ nee (numbr! aM stree4 , slate, arM LP oode)
� �� v.�e �
Dons apPlitanl own property' ny other If yes. what munryl
counry m Ind'ana? .. r� ..
appmved'v� Ihe amwnt ot
zo I zo I zo
A�Mitor
1/ We certify under Ne penalry of peryu[f that
owner I contrad buvef of the afofementimed
�f owned wiN
��
za
�6
20 _
Caunry
d foregoing infortnation is We and ca
date appfiratlon is filed. _
Yes U No
Is ihe praperty in question: MnuaOyASUSSed
� Real Pfoperty Q Nmually A55E55ed
Has �his dedu�on Eem m9uestea on P�W�Y
hrartentyea(f ❑ Yes ❑ No
1�vNcmty�Z ,io.sE,ua �
SFfJ�Ni�oN �
/�2 -� 9a �
.� , �
��.� " � � J�\ �.�
Fy�l revf''dent a0 of a � umberer�Q sLe�t, dry, yate, �� P g�
� 1 l i \�' 1 �J � i-t ) 1
Pason autM�.d by Etdy ezewte0 Power o(Atmrtrey w by IC 61.1-12-0.7
Mdmss ot authoraed peison (numberarM sbaeL dry, s+ate, en0 LP cotle)
Dace