HomeMy WebLinkAboutMortgage_Kiesel (3)�
STATEAAENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fwm a3)O9 (RS / 4-03)
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� PrescribeE by Department of Laal Gtivemment Finance
INSTRUCTIONS: „ � ��F�j �' •,
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To be filed in person or by mail with the CountyAuditor of tbe counry where the property is locateaaa�-�� ��� �%
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ tAe year the deduction is to�e effecti
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year�A�ed�io(hFS�o 6e e/fective.
See reverse side /or additional instn�ctions and oual�cations.
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Applicant (owneror,contract buyer- se 2s ons on reverse sid ) ✓ ��vSp;1 C" ,n�TY 'r.L^•:�`�
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Taxing Distrid Key number / legal descripC n Record number
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Page number
00°��-d/ 78'
Assess value of real property as of Mortgage / Contrad indebfedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, current year owneR ❑ Yes ❑ No
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if no, what is his / her exact share of interest? If owned wifh someone other lhan spouse, indicate with whom.
If name on record is different lhan thaf of applicant, indicate below: Is the property in question:
�❑ Real Properiy ❑ Mobile Home (IC G1.1-�
�me of mortgagee or contrect seller
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Address of mortgagee or contrad selier umber nd street, city, state, Z/P
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZlPcode)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yeaf? �] Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 �� 20 _� 20 �� 20 �_ 20 20
I
Signature County Audilor Date
�'�. We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
;esident of Indiana and owner of the aforementioned property on March 1, 20
Signafure (owners full name) Person authorized by duty executed Power of Attomey
� � or by IC 6-1.1-12-.07
Full resid nl addre s of applipnl Address of authorized person