HomeMy WebLinkAboutMortgage_Koberstein STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.
:a FOR DEDUCTION FROM ASSESSED VALUATION
State Form (R„/6-09)
Prescribed by Department
I
of Local Government Finance
Pile Mark
INSTRUCTIONS: nf,rty 1,LL
To be filed in person or by marl with the County Auditor or County Recorder of the countvr*re®e pr���r is located. Form Sled with:
Filing Dates: 1) Real Properly Must file during the year for which the deduction is soup L County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve 12)coo the
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
Appfxant(owner boyar-sae s reverse �Q, ,�,,� lGIIB COUNTY Al MITOR
-SON
T tea'-oaci i4—roo 000 .4.9 a fin 1 Record Page 7
Assessed value of real property as of =Tool indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March t;current year =,Y1 ♦ date aF apptldatron o equitable owner?
75Cr - ❑ Yes ❑ No
If no,what s his/her exact sham 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 properly in question:Annually Assessed
❑Real Property ❑Annualy Assessed
0-43 Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,day,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any otter I If yes,what county? • what Taxing District? Has this deduction been requested on property
county in Indiana? n. ❑ Yes_ for current year?
-
Dyes ❑ No
V -to411 C'' COUNTY AUDITOR
Ifir- B O _ 20 20 20 20 _
I County
' Date(montU„day,year)
. . ....—..1 .r r._
_ __.,,.y uamer 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 contract buyer of the aforementioned property on date application is filed.
c (o —� Date(rtrmd,day,year)Y1 k ff.__ \-\ C t
resident
address of applicant(number and street.aTy,state,and ZIP code)
0%3 ktO�\ C. 'ac E . CiRL`f�\n-'4 Q;ice \1J- `\�lakno
Person authorized by duly executed Power of Ntaney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,stale.and ZIP code) .