HomeMy WebLinkAboutMortgage_Koberstein (4)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count w hip e
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6-09)
�+ prescribed by Department of Local Govemment Finance
INSTRUCTIONS: Form ed with:
To be filed in person or by mait with the CountyAuditor or Counry Recorder of the county where the property is located. tor
Filing Dates: 1) Real Property: Must file during the year for whieh the deduction is sought. G' SO�����e1n'r
2) Mobile / Manufactured Homes not assessed as Real Praperty: Must file during the twelve (12) months ��f�,J�TO
before March 31 of each year the deduction is sought.
See reverse side for additional instractions and qualfications.
qppii owne conUact bu er - e rest '' o reverse side) �
T i Key ber I legal descrip n Record number Pa e nu
, - � D -�Q/. //� aa�
value of real propeAy as of Mortgage! ConVact inde6tedness unpaid as of Mo�qage / Contract indebte�in unpaid � �S a� ����e owner?
�� � q� �r March 1, current year date of ap lication /_ � i�/Y� �
(f� �1,�C(.e/ � yes ❑ No
If no, what is his / her exact share of interesY? If owned virith sameone other than spouse, indicate witli whom
Is e property in question: Mnuaily Pssessed
If name on record is different than that of applicant, indicate below: R�� pr.o��y � q�uaiy Assessed
Mobile Home (IC 6-1.1-7)
�
/
Name of mortgagee or contract seller
Address of mortgagee or contract seller (nu er and street, city, state, and
Name of assignee or other owner or hdder of mortgage /�
Address of assignee (number and street, ciry, state, and ZIP code)
Does aQpliqnt own property in any other
county in Indiana? � Yes
Deduction approved in the amount of:
20
Signature of County Auditor
If yes, what counq/?
No
20 � 20
WhatTaxing District?
COUNTY AUDITOR
20 � 20
Has this dedudion been requested o� propenl/
for current yea(? � �,� [� No
20 _ � 20
� KU �E�2 S i �, .� � G�,
��ri �� �s � �
I! We certify under the penalty of perjury that the above and foregoing infortnation is Vue and corre�
owner ! conUact buyer of the aforementioned property on date application is filed.
�n (owners full nam�y � „ �/ -
state,
authorized by uly executed Power of Atfomey or by IC 6-1.1
Address of authorrzed person (numberand sheet city, state, and ZIP code)
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D�- 83�8
Date (month, daY. yee�