HomeMy WebLinkAboutMortgage_Krieg STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Q!+1Il�tar
tYFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) �•Prescribed by Department of Local Government Finance
INSTRUCTIONS: i MA Tad'2013
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. I r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mom
before March 31 of each year the deduction is sought. ufi6S0' C Ntiur mrde,L
See reverse side for additional instructions and qualifications. 1 V K
ApfLcant(owner or contract see re sort reverse st r�
Taxi -key number/legal description �J _f Record number Page number
sro - 1 - l& — 1 °e( - OM i- n0-�-1 orb(.- r) b
Assessed value of real properly as of gage/Contract'indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,one year rh 1 ounent year date of application legal rrAeq� M
equitable own
( ,53) D (PI Yes El No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom J
If name on rend is different Ran that of applicant.indicate below. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of ee or contract seller
ATfdress of mortgagee or contract suer(number and street,alt',state,and ZIP code)
' _
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cilY,state.end ZIP code) /
act\� •
Does applicant own property in any other If yes,what county? Y C; �O•• • • 5� pent'
car p,5``
El Yes �3'NO pl�,.•'•• No
•
COUNTY AUDi 6\0
1
Deduction approved in the amount o. Cad S1•/1 9 /.
20 20 20 20 -I \ I 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signs o Mina ) Date(nmM,day,)ear)
grsi en t num r street,city, Si and ZIP code)
`Y S`jw c C&rnrd Pave MrMiceo -TN L(167
Person authorized by duly executed Power of Altomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) -