HomeMy WebLinkAboutMortgage_Krieg (4)'q STATEMENT OF MORTGAGE OR CONTRACT 1NDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Shate Fortn 43709 (R71 / Cr09)
� prescribed by Department of Lopt Govemrtient Fnance
File Mark
�.STRUCTIONS: F m d wit
To be filed in person or 6y mail with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dafes: 1) Real Property: Must file during �e year for whieh the deduction is sought. �
2) Mo6ile / ManuFaciured Homes not assessed as Real Praperly: Must fiIe during the lwehre (12) months - County Recorder
before March 31 of each year the deduction is sought
See reve side for additional instructions and qualfications.
Appli r or contrad buyer - see restrictions n reverse side)
� I . i w � .'-
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Ta�ong Distrid Key number/ legal 'pdon DITOR
a� - i _ 8 - /oa-oov.iai - ov �
���M�yp,ar � �� March 1 ar�re^t y e�ndehtedness unpaid as of � O� ag pP'Co�i �d indebtedness u�paid as of legal orPePquitaWe owne(1
�% (' � O O ❑ Yes ❑ No
fl no, what is his I her exad share qf interest? If owned with someone other ihan spouse, indicate with whom
If name on record is dHferent than that of applipnt, indiqte below:
Name of morteagee or contract seller �
Address of mortgagee or contract seller (num6er and street city, siate, and ZIP code)
Name of assignee or other owner or holder of mprtgage
Address of assignae (number and street city, state, and Z1P code)
Does aQplicant oum properly in any other
county in Indiana? ❑ Y� ❑ No
Deductlon approved in ihe amount of:
If yes, what countyi
couwrv
20 _ � 20 � 20
p( County Auditor � �
20
0
Is the property in quesdon: Annually Assessed
❑ Real Proparty ❑ Armualy /�ssessed
Mobile Home QC 6-1.
Drativer NO.�DI�.:.......
c�,-� nTo. . Si� ���,p��
.................... Yes ❑ No
County
20
20
Date (month, day, yea�
20
I! We certify under the Penatty of perjury that the above and foregoing infortnation is true and correct and that the applicant is a resident of Indiana and
owner / contract buyer of the aforementioned property on date application is filed.
. _ . _ ..�--� - • � Date (mor+th, deY.l�er�
Full
crty, state, and ZIP
auUwrized by duly execuied Power ofAttomey or by IC 6-1.1-12-0.7
Address of aufhorrzed pe►son (num6er and shee4 city, state, and ZIP code)
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Date (month. daY. Y��