HomeMy WebLinkAboutMortgage_Kiesel STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-- State Form 43709(R11/6-09)
�': Prescribed by Department of Local Government Fnarce
ile
INSTRUCTIONS:
Fenn filed with:
To 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 0 T Q to Sat Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
(o
App
ca wnero conbitittrye��she ceou�re'erse side_ _ _ GIBSON
/(` (�'d'<<J hi ���Q'�{�y`l COUNTY AUDITOR
Ta Disoi t Key number/legal description Record number Page number
A l a - /0 0-0 0/ e-o (3 3 a-ob
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Ls the applicant the sole
March 1,anent year March 1,anent year date of appttcalion IeoatoteouitaN^!..-'
D-lo S3/. $)- 1 -
If no,what's his/her exact share of interest? If owned with'
. .'
If name on record is afferent than that of applicant,indicate below I
�,�sq%c.9�'
Name of mortgagee or contract seller i��. --A. v ~ -,'•
.
•
Address of mortgagee or contract seller(number and street city,state,and ZIP code) I (303- 3 ar O $ 1.
Name of assignee or other owner or holder of mortgage I 1 )5 'J j 5 al
Add of assignee(number and street,city,state,end ZIP code) 6 c_
l/Yn J
caw 3y co N
Does applicant own property in any other If yes,what county? • What Taxing D5
county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR I
Deduction approved in the amount at I
20 20 20 20 I__ X20 20
Sgna�mr - s au
Cnry Date(month,dart year)
I 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 contrail buyer of the aforementioned property on date application is filed.
Data(month,day,Yin
-n e(owners to n et/ `
Fun resident add of appOcant(number and se (
obt st ate,and code)
rv6rov s- sio w. ilai,ts /Alt iN q7 31
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(mined',day,year)
Address of authorized person (number and snot city,state,and ZIP code)