HomeMy WebLinkAboutMortgage_Kixmiller�n .
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �-c=oun .,�r �Tvwnship�, Year
• - ��' ✓ State Fortn 43709 (R514-03� � � � �
� Presciibed Cy Depanment of Local Govemmeni Finance
Ut,l iLU7
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audiror of the county whe�e the property is located. �vv-�
Filing Oates: 1) Real Properry: During the 12 months before May 11 0! the year the deduction is to be effe� e� �(/
� 2) Mo6ile Homes assessed under IC 6-1J-7: Between January 15 and March 2 o/thA=year•"tA'e��ductiodis�oT6eReffective.
See reverse side for additional instructions and quali�cations.
�owner or con�ract nqyer - see restnc6ons on reverse side)
�"
Key number / legal description
� �
Record number �
� _ � Page number � �
Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant ���th���e ^^^sole legal or equitable
March 1, current year March 1, current year owner? �ses ❑ No
/� 000 �
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 than thal of applicant, indicate below:
of mortgagee or contrad seller �/�
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owrier or holder of mortgage
Address of assignee (numbe�and stieet, ciry, state, ZIP code)
Does apPlicant own property in any other If yes, what county? What Taxing Distriq?
county in Indiana?
20 �
P
Signature
approved in fhe amount of:
� Y:
�
.
COUNTY AUDITOR
20 _� 20 20
� County Auditor
Property ❑ Mobile Home (IC 61.1
Has this deduction been requested on
propeAy for wrrent year? � Yes ❑ No
20
Date
20
certify under the penalty of perjury that ihe above and toregoing information is true and corred and that the appiicants was / were
lent of Indiana and owner of the aforementioned properry on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
residenl address of applicant � Address of authorized person
5�3 G�(.P/1it u .�.�P�in . �iy.ir�r�fn