HomeMy WebLinkAboutMortgage_Kolb (3) �s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun �r nshlq� 1 r
' ;; FOR DEDUCTION FROM ASSESSED VALUATION Ty� q A d
`' State Form 43709(R11/6-09) JL 11.1
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Prescribed by Department of t.ncol Government Finance M9
INSTRUCTIONS: 6l. I lrkl 2013
7o be filed in person or mail with the County Auditor or County Recorder of the county where the properly
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Pe by h ry h P PedY k located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I s 4.4.4:24)..• •
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months )-:. �,J,�hr rdei
before March 31 of each year the deduction is sought - GIB'•N ylt �+•-." • v o i f t.1 R
See reverse side for additional instructions and qualifications.
Appfira -rorcantracr.r r-;.-restriliwns rse site)
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"r A / mbar/leg-I description Record number Page nun
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Marsh 1,current year date of application legal or equitable owner?
(� ❑ 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 applicant,Indicate below Is the property in question:Annually Assessed
Real Property ❑Mobile Assessed
• ���`�� hloWle Hame(IC 61.7-7)
Name of mortgagee or contras seller
Address of mortgagee or contras seller(nu �st iry,state,a72474_62/Lei ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city slate,and ZIP code)
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Taxing Does applicant own property in any other If yes,what county? - What Tang District? lias this deduction been request on property
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 I 20-_I 20
Signature of County Auditor County ^�'^[/7-
I I We certify under the penalty of perjury that the above and foregoing information is V D) 15 C l ,1 O•••••... ma and
owner/contract buye of the aforemenfion-. ro.-rty.. Y � P rty on date application is filed. I
r4- e �/Sr/ Card 1 '0. ...1.. a8". .
Fu resident address of applicant(nu •-r and'street city,state,and jr code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .