HomeMy WebLinkAboutMortgage_Kiesel: _,.�,�
;e� ~. ''4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' ��= FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�> �. ! State Farm 43709 (R6/ 5-OG) �{{� yy �
� I� � Presaibetl by �epartment of Local Gov�nt �nar}'je ��
g�J D LY ENTERED OR TAXATION
Subject fo final aaeptance or frans er
INSTRUCTIONS: JUN 1 1 ZOO� _day of F'ir nna,k_
To be (iled in person or by mail with lhe County Audrto� of the county where the�propeRy is located.
Filrng Dates: 1) Real Property: Dunng the 12 months efore Jur�� Il of fhe year the deductio e��,,s-c� Audilor
2J Mobile Homes assessed under IC ��Y'��tween January 15 and March o/t e�'dr the o ppctiq��dp��ective.
' 'TY AUDiTOR v
See �everse side fo� additional instroctions aria���llica�'�ii§. Parcel �
Applicant (owner or contra yer- e strictions on 2ver e'de) �� ///�^`�'C
�
Taxing Dislrid y number / legal description Record number
- 7—�%
�%'�9-010 O�� -i7��. Ue1S'"ber
Assessed value of real pro erty as of MoAgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cu�qnt year owner? ❑ Yes ❑ tJo
G�'
S 0 00
If no, what is his / her exact share of inlerest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the properiy in question:
❑ Real Propea{y ❑ Mobile Horne QC 61.1-�
me of mortgagee or contrad seiler �-+
�J
Address of moRgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other Ii yes, what wunry? What Taxing District? Has this deduction been requested on
county in indiana? propeAy for wrrent year?0 Yes� No
^^��uT� e��nITOR— -
Dedudion approved in the amount of: ����(� /'J/i�%�Qr(,( (.�%
���� �
2� � 20 2� �� _ 20
P � � ��!" � ��
Signature County Auditor
We certify under the penalty of perjury that the above and foregoing information is true and correct and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (ow rs (ull na ) Person authorized by duly executed Power of Attomey
r��i.\ or by IC 6-1.1-12-.07
F II resi ent addre s of applipnt Address of authorized person
�° �� so�ti a5 E �t �`m�h zN