HomeMy WebLinkAboutMortgage_Krieg^�n STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
. • Slate Fortn 43709 (R71 / 6O9)
�,w f presaibetl by �ePartmeM al Lntal Govemmem Fuance
I� '
wsrnucnoNS:
To be fiied in person w by mail wifh the CountyAutlitor or Counry Rern�der ot the counry wheie the property is located. AU Fp�m A�(yyq
0 11L
Filing Dates: 1) Real P�operty Musf file during the year for which tAe deduction is sought. � County Audimr
2) Mo6ile / Manu/acfured Homes nof assessed as Real Properfy Must file dunng the fweNe (72) months C� un Recorder
befoie March 31 of each year the deduction is srought. h'
See 2verse side fnr additional instrucfions arM qualifiwtions.
noo�icamlownerormnhactbu/'er-see mreverseside)
Taung Oistrct Key num al tic
a i�-
a��n,ed�v�v�w M rt�ee�
Mart�h 1. Mati 1'� 1. c
tl ro, what'a h's I her e�ct share o/ intrlest?
It nart�e
that o/ app5pnt, u�tlifate 6ebw:
Nartre ot nwtgagee or cmtracl se�er �
/
PCdress ot �mt9a9ee a mntract sWer (numAer en
Name of assignee or other owner or hdtler W rtartg
AdEfess o ignee (number aM treet ciN. slate,
aPplirant own propnJty in any oNer
cou�LLy m Ind'ena?
❑ Yes No
Drduc6m aroraved m ihe amount of.
� � p
I I We certify uMer the penalry QYperjury that
owner I contract buyer ot the atorementloned
_ o "- 000. /!o y - o z �. -- � � "3 �Y 7
a'uWehtetl� unPaid as W Morlga9e I ContrarY uNeMedness unpaid a d Is Ne ePP���� Me sok
rar date oF z7P��� � n eWitable axnM
81 nnn ❑ Y� ❑ No
cdy. sfate. aM ZIP code)
If yes. what
�
K awned wiN wmeane
D¢trirl? —
,���
Is Me ProPertY in Cuestim: MnuaOY Assessed
�ea� Rovertr ❑ M^ually.ASSessed
teA an property
— C'I. �
COUNTYAUDROR DI'1�1'(,'1'1�0.;•,!;�',�.
zo_ �_ c��-� ��To. ...3�y'�%
Counry ,
�'1G,�gj��j.
nd foregoing infortnation is We and cortect and ihat the applimnt is a resident of IMiana aiW
date applitation is filed.
Date (monfi, day, ysa�
�uil rPSitlent addrrss ot app�rant (number antl sLeet, riry, slate, and LP cotlej
�Or c CIFa� s�• Owo�su;\le , iei
Pe�son authoraed by EWy ezewtetl PowerW Aftor�y ar by IC G7.1-12-0.7
Add�s of autharzed pert.wi (num6er a� stree; dry, stafa,
Date (monN. daY.
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