HomeMy WebLinkAboutMortgage_Kiesel (6)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R11 / 609)
' , � PresaiEed by DepartmeN of Lofal Goremrt�enl Frurce
w.
File Mark
lSTRUCTIONS:
To be h7ed in person or by mail with the CountyAudito� or County Recolder o( the county where the piopeRy is bcated. AU o e
Fifing Dates: 1) Real Property: Must file during the yrear /or which the deduction is sought. County Auditur
2J Mo6ile /ManuFacturnd Homes not assessed as Real Property: Must fife during the hvelve (12) months C.
befole March 31 0/ each }rear the deduction rs soughG ��nh Recorder
See 2verse side /or add'rtbnal instrucfions and quali�cations. n i c cnu cni i N7v Al l D ITOR
�z^=� Key rnimber / al desaiPtion Remrtl num
�6- �-.3�_�00_000. ao�_oo9 O
ed vehc d real poperty es ot MoRgape / CantraG indebtedness unpaid as o( Mortgage I ContraU inEebtedness unGeiE as M
�, aamnt yea Mard� 1. a�rtent yeer date of app&ation
�t ro. wnat ts rus � Iwi eraa snare of Yf�.
tt narne m remN'a EiRemnt Nan WI
Name of nnrtgagee a mntrac� seAu
Add2ss ot �mtgagce or contract selle
Dces appficant own G�P�Y in any �
counry in Indiana?
❑ Yes
DeducUOn approved in Ne amwnt oE
If awned wiN
K��s�, v�� y 2 -
_,_
�5-��/
Nrtwt Taring Districl7
1'C-'=i��iL•]
Is tl�e properry in QuesUOn: MnuaOy Assesud
❑ R� ��� ❑ ���
MoWle Hane (IC 6
Has ih"s deEuaion Deen re9uesteO m property
mr a,rtern yean
❑ Yes ❑ No
20 20 20 _ 20 _ 20 20 20 _
Signanne W Co�mN Aueitor Caunry Dete (manN. daY, l'ee�
e_7.
I/ We certify under Ne penalry of pe ry that the a arxl foregoing intortnation is true and cortect and that Me applinnt is a resident of Indiana arM
owner I mntrad buyer of the aforementioned pro on date appiication is 51ed.
Puson auNO�aed by
person
(num6er and stree4 dry sfate, end ZIP cd
,9Pc � s�
� aowe� oran«„er w ny ic 6,.,-,s-0.�
svee4 �: state,
Date (monfh, daY. Y'�e�
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