HomeMy WebLinkAboutMortgage_Kessens STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
's; FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(RD 16-09)
Prescnbed by Department of Local Government Fnance
File Mark
INSTRUCTIONS:
- • :..1r!: I -
Tb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Oita'
2) Mobile/Manufactured Homes not assessed as Rea Property Must file during the twelve(12)months
before March 31 of each year the deduction is soup . - ecorder
See reverse side for additional instructions a qualifications. GIBS f: • - • • -
Ap• owner or contract buyer-see on re side)
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ortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of app/ca:ion legal or equitable owner?
/ / COD ❑ yes ❑ No
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 that of applicant indicate below'. Is property in question:Annually Assessed
Is
Property ❑Annually Assessed
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Mane of mortgagee or contact seller // /J
Address of mortgagee or contract seller(Jumbo( street,/ city.state.and Z e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? bias this deduction been requested on property
county in Indiana? El Yes El No for=rent year? ❑ Yes ❑ NO
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 .20 I 20 I 20
Signature of County Auditor /�,� '^ • year)
I I We certify under the penalty of perjury that the above and foregoing infon D I a\l L 1- NO U_C-IQY�/:fCf/uu1//)l 'ent of Indiana and
owner I contract buyer of the aforementioned property on date application is �/�
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Ftdresident address 1(number and street,cdy state,and ZIP cod
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorbted person (number and street.arty,state,and ZIP code) .