HomeMy WebLinkAboutMortgage_Kruse (2)�'� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S J Siate Fortn 43709 (Ra / 10-01)
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�� Prescribea by DepaMrent of Local Govemmeni Finance
�NSrRUCnoNS: APR 2�e�p�
To be filed in person or by mail with the County Auditor ol the county where the property is located�
Filing Dates: 1) Real Property: During the 12 months before May 11 olthe year the deduction is to e eflective.
2) Mo6ile Homes assessed under IC 61.1-7: Between January 15 and Ma�ch 31 0/ � is t e ective.
See reverse side for additional instructions and qualifications. ��BSON COUNTY AUDITOR
Applicant ( wn contrac( buyer- see rest ' ns on reverse � e)
Taxing islrid Key number / legal scription Record numb
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Page number
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.1-�
Name of mortgagee or contract seller
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Address of mortgagee or contrad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrenl year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
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Si alure I County Aud'Aor Da e
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I/ We certity under the penal of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20 .
ture (owners lull name) Person authorized by duly executed Power of Attomey
,< or by IC 6-1.1-12-.07
F sident address of applipn �'� ddress of authorized person
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