HomeMy WebLinkAboutMortgage_Kiesel (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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�� Presaibetl by Depariment of Local Govemment Finance `` —
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INSTRUCTIONS: A�R 1F�e�
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng fhe 12 months be%re May 11 0/ the year the deduction is to be effective. � /
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ t6e year tAe deduction is to be�eHe�tive.
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See reverse side for additional instructions and qual�cations. >�1ut � r^ .
Applica (owner or contract buy�ee restricticps on reverse side
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Taxing Distrid Key number / legal descriplion Record number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant ,th,,e! sole legal or equitable
March 1, current year March 1, curtent year owne(? � res ❑ No
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If no, what is his J 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 lhe property in quesiion:
/a Real Prope�ly p Mobile Hortie (IC 61.1-�
�ame of mortgagee or contract seiler
Address of mortgagee or conlract seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, 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 current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 O� 20 20 �� 20 � 20 20
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Signature County Auditor Date
��/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
Si ature (ow ers (ul e) � Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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