HomeMy WebLinkAboutMortgage_Kiesel (7)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSEO VALUATION Coun 7ownship vear
y µ. � State Fofm 43709 (R4 / 70-07 ) J Y ':_,1
� PrescribeA by DeDartmenl o/ Locxl Govemment finance �
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INSTRUCTIONS: �AN `Z 4 ZQB� Mark
To 6e filed in person or by mail with fhe County Auditor of the county whe2 the property is lo ted.
Filing Dafes: 1) Real PropeRy: Dunng fhe 12 monfhs belo2 May 11 of the year the deducti�s to be eS�ctivy� n �
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March����theydeducti y_ js,to be ef/ective.
See ieverse side loradditional instiuctions and qualifications. �� GtESOtJ CC! �n'? �� e.UQITOft �
Appiicant (owner r contract buyer - see restrictions on reverse side)
Taxing Distrid Key number / legal desuiption Record numbe� -� O
a ��
p I Page number
/�?�n�/V Q /l - 6a i�i7 - �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
�sa s oG
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Properly ❑ Mobile Home pC 61.1-n
me of moRgagee or contrad seller
� -5/ 3
Address of mortgagee or contract seller (number and st2et, dty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counly in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �,� zo 20 �� zo �� zo �_ zo �� zo �_
o � � P P �
Signature Counly Auditor Date
'/ We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on Marcn 1, 20
�
" nature (owners full nam ) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full residen ad e of appli t Address of authorized person