HomeMy WebLinkAboutMortgage_Krieg (3)n STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 93709 (R71 / 6-W )
, i P�esaibetl 7Y �PartmeM of LOW Govemmerrt FirerCe '
INSTRUCTIONS:
To be filed in person or by mail wrfh the CountyAuditor or Counry Recorder o7 Ne county where the property
Fitirg Dates: 1) Real Pmperly Must file Cunng Ne yrear for which Ne deduction is sought.
2� Mobi7e / ManufaUUred Homes not assessed as Real Property: Must file dunr�g the IweNe (
6etae March 37 of each yeat Ne deduction is sought.
See reverse side ior additional instnxtians arM qualifications.
Aoofuamlrnmernconnect6wer-seeresairaonsmre ' 1 f / .
�
Me� 1. ane�rt yPar
i 110.'N�18� �5 �16 ��IM B]Yfi
tt nama on �emtd'n C'ittem
�
,a5o1 A�pr�p�g a/ConO
Mardi 1.airrerrt
W9 O:III}P1PSl�
han Ma� W app6rant h�OkaOe Deb�'
Nartm of mortgagee ar contraa seBer
Aedress of mortgagee or contraa seAu
Name of asvgnee w other owner w hd
AdAfass of essi�nee (num6er erW stree
Oces ePp1i�M own praperty in any oNe
munty u� Indiana? � Yes
peLUGtim epp�wa0 In tlfe artpunl ot. ,
� �_
SianaWre Of CamN NWRw
G1".5�.-'.rc-�•�'➢
as
ispaiE as d
I ❑ Yes ❑ No
wiN someone oU�er Man spouse. Ind'zale wtth M1m�
Is tl�e P�GQnY in Oues6m: MnueOy Asscssed
❑ Real RoGartY ❑ %���b �
Moble Flome OC 61.1-�
D1':11�'CI' �i�....�l.O....... �?
C1C(1 ��. ......�;1,1.........
�-i �a �� CO
20 20 _ 20 _
Nas tnis deEUdian Deen rcVUnsteE m 7�Y
fw wrtent Y�aY7 f'1 .,_ _ fl �
2q � 2(1
I/ We certify under Ihe penalty M perjury that Ne above and foregoing infortnation is true and correG and ihat Me applirant is a resident of IMiana and
owner / mntrad buyer of the aforeme�rtoned property on date application is filed.
7naLrte fG�MYi%iVll reme) . Data (mavh. daY• Yae�)
Person auttrorisd Oy Euly nsew ed Power o(Attomey or Cy IC 61.1-12-0.7 I�� (��N. �Y• Y��
Pddress ot auUwr'vid pttso� (num6er arW stree4 uN, s+a�e. and LP code) .