HomeMy WebLinkAboutMortgage_Kremer�
'' ,w. � c
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR OEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (RS / 4-03)
PresaiDed by Department of Lacal Govemment Finance
Coun Township Year
�TRUCTIONS: File Mark
� De filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: iJ Real Property: Dunng the 12 months before May 11 0l the year the deduction is to be,eflecfive. i �, ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 ofthe ye2r'the ileduction is to be efiective.
See reverse side /or additional inshuctions and qualifications.
� � Ji�� = J
DEC 1 2003
Applicant (owner or cont t buyer - see restrictions on rev rse side)
.��..-��} �.���-i�
Taxing District ' Key number / legal description Record'numtiery ����+� T„'�"''' '
l/�J',� ` � 0 / VW �.J6 (.LJ Page number O��
Assessed value of real property as of Mortgage / ConVact indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year owner? ❑ Yes ❑ No
I( 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 than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
Name of mortgagee or contract seller
�ress of mortgagee or contrect seller (number and st2et city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applicant ovm property in any oiher If yes, what county? What Taxing District? Has this deduction been requested on
counry in Indiana? property for current year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 � 20 OFs 20 � 20
/ � � �
Signature Counry Audiror Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and corteci and that lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
,n ture (owner 1 n e) Person authorized by duly executed Power of Attomey
or by IC E1.1-12-.07
Fu re ident address of appliwnt Address of authorized person
�a