HomeMy WebLinkAboutMortgage_Kieferro� STATE�d�NT OF MORTGAGE OR CONTRACT INDEBTED
FOR DEDUCTION FROM ASSESSED VALUATION �� Co ownship Year
� I State Fortn 43709 (RS / 4-03)
�� Prescnbed �y Departmem of Local Gcvemment Finance � R 1 9 2OO
INSTRUCTIONS: `�I�O� ,�i � File Mark
To be filed in person or by mail with the Counry Auditor of the county where fhe property is locat2d. (/ Y' A�pITOR
Filing Dates: 1 J Real Property: Dunng the 12 months before May 11 of the year the deduct%q$� ��tive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March`� o/ the year the deduction is fo be eRective.
See reverse side for additional instructions and qualifications. '
Applicant (owner
see
side)
i axmg uisma Key number / legal description �—' F�kcord number Q�
�/�/^� �O � V� JO� '�� Page number �
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of. Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
� � vV v .
It no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than ihat of applicant, indicate below:
mortgagee or contrad seller � � �
of mortgagee or contrad selier (number and st2et, city, state, ZfP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eef, city, state, ZIP code)
Does applicant own property in any other I It yes, what county?
county in Indiana?
approved in the amount of:
20 �1 `I 20 f�
Q ` P
Signature
couNrv au
20 t! 20
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County Auditor
Is the
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� Mobile Home QC G1.1-�
1
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a°►�S
quested on
� Yes ❑ No
, We certify under the penalty of perjury lhal lhe above and foregoing information is Irue and corred and that lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�/� r Addres5 of aulhorized person
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