HomeMy WebLinkAboutMortgage_Kaiserf��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS —
= FOR DEDUCTION FROM ASSESSED VALUATION C n TowSiship [i Year
's.. _ y Syte Form 43709 (R6 / 5-06) �
«
Presaibed by Department of Local Govemment Finarxe
�• A
INSTRUCTIONS: �ile M�/
To be Fled in person or by mail with the County Auditor of the county where the property is located. �� Q�
Filing Dates: 1) Real Property: Dunng lhe 12 months before �une I7 0/ the year the deduction is to 6e e(�igON COUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to 6e ellective.
See reverse side for additional instructions and qual�cations.
Applicant (owner
Taxing Distrid
buyer-see
t .
.- � -� -
Assessed value ofrealproperty as of
March 1, wrrent year
16no, what is his / her exad share af interest?
on ceverse side)
Key number / legal description � Record
[►7
_��y � rage numcer I I`�
` `.i
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, current year owneR ❑ Yes ❑ No
If name on record is diNerent than that of applicant, indicate below:
�e of mortgagee or contract seller �
e
Address of mortgagee or contract seller (number and sf2et, city �
Name of assignee or other owner or holder of mortgage
If owned wilh someone other than spouse, indicate with whom.
ZIP
�
Atltlress of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what countv? �^^�^� T- ' - ?
counfy in Indiana?
Dra�ver NO...°2.��v�•.� u�
Deduction approved in the amounf of: C ard �� '•"(�"�"+ "o '�
�/ �i • C�i � d 6 . �
O
zo �� 2o C�°i 20 20 _
�P n
County Audilar
Is lhe property in questian:
❑ Real Propc�rty ❑ Mobile Home pC 61.
Has lhis dedudion been requested on
propertyforcurtentyeaf?� Yes� No
Zo
Date
zo
certify under the penalty of perjury thai the above and foregoing informalion is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
full name)
% r� /CcU.-°�
;ident address ot applicant
� � s. c� f��s� Ff_ a,-.,.�,�i..r,��r��
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person