HomeMy WebLinkAboutMortgage_Kramer (13)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � Stale FoRn 43709 (R4 / 70-01) -
� — � ,
�«. �
� PresaibeA trj DepaNrenl ol Local Govemment Finan[e ' ���
i Fi�
iNSrRUCnonrs: APR 2 �F����*
To be filed in person or by mail wifh the County Auditor of the county whe2 fhe property is /ocated.
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is �o be effective� /n/
2) Mo6ile Homes assessed under IC 61J-7: Between January 15 and March 31 of t�ie year the;deducUon-is to ba'eBective.
See reverse side (oradditional instructions and qualifications. �GI�QOt! C�i�t1F" �' °�'����P 1
Applicant (ow er or conliact buyer- see 2sMctions on reverse side)
�°4 `� ��
Taxing Distrid Key number / legal descriplion Record number O�
OQ� ^ O Page number /�
Asse ed value af real property as of Mortgage / Contrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, current year March 1, current year ownef? es ❑ No
( � ����
If no, what is his / her exact share of interest? If awned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
eal Properly ❑ Mo6ile Hmie pC 61.1-�
�me of mortgagee or contract seller
�- 3 � �
Addres of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Tauing DistriIX? Has lhis dedudion been requested on
county in Indiana? property for current yeaR � YesO No
COUNTY AUDITOR
Deduction approved in fhe amounl of:
20 �_ 20 20 20 r� 20 �� 20 � 20
� � r
Signature County Auditor Date
�' We certify under the penalty of perjury lhat the above and foregoing infortnation is true and cortect and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
� _ or by IC 6-1.1-12-.07
Full resident address of ap iqnt Address of authorized person
b r �! YJ�39
..�.