HomeMy WebLinkAboutMortgage_Kohlmeier :?'?'.,
r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�,; FOR DEDUCTION FROM ASSESSED VALUATION
t'l State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance — -
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INSTRUCTIONS: Foci d ill 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Ring Dates: 1) Real Property Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is .ht - n Co er
See reverse side for additional instructions and`=liflcations. _ Ty AU
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Tap.(; ' ben/l d tion t2 P n ber
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_.wade of of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the •
March 1.current Marti 1,current year date of application/S� //a, p pI ❑ Yes ❑ oN
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with wham
If name on record is dRerent than that of appricant,thaicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller ( /(n r 1 S &
Address of mortgagee or contract seller(n and street,coy.state and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street ray.state,and ZIP code) l/
- /) . J. -i, • — 16--G- 7 ,/- 8 '/-9•,
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.ty? I What Taxing District? I Has this deduct been requested on properly .
1 for ❑ yes ❑ No
r Drawer NO � /
r .ter q COUNTY AUDITOR
I Card NO. $3y
eatjclantsi ,Op . 1.{c41321nLizt 20 20 20 20
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Signature d ''itor � /i County Date(month,day.year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1.. .-. buyer of the aforementioned property on date application is filed.
*nave . es d na d I Date(rtmN,day.year)
Fte .:. .4. ...I miter street aim,state.and ZIP code)
- authorized by dtdy executed Power of Mooney or by IC 61.1-12 417 Date(month.day.year)
Address of authorized person (number and street coy state,and ZIP code)