HomeMy WebLinkAboutMortgage_Krieg (6) STATEMENT OF MORTGAGE OR CON I it WE'D County Township Year
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FOR DEDUCTION FROM ASSESSED VA A
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- State Form 43709(R77/6-09)
Prescribed by Department of Lod Government Finance MAY 0 7 2014
File Mark
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of th- .. • located.) :; r1.l�i• 'petty is lo Form filed Mn:
Filing Dates: 1) Real Property:Must file during the year for which the deduction : /• BB County Auditor
2) Mobile/Manufactured Homes not assessed as Real • •41:t? - f-f• • gYdl®0f11Q11)months
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restriction reverse side) e
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T Oistrr2 Key mum al description Record number Page number
7tc<,c� 2 to- 0 -17- 30 3 - nor f) 97-095 /q /34/c'
Assessed value of real property as of Mortgage/Conrad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as d Is the appr�nt the sole
Mardi 1,area year Mardi t a�rrteTnt^yyyeeeaaarrr date of apf�ication legal or ew�table owns?
VV ❑ Yes ❑ No
If no,what O he I her exact share of interest? If owned with someone other than spouse,indicate with Mom
If name on record's different than 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 mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
A e
Address of assignee(number and street coy,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Is
county in Indiana?
❑ yes ❑ No q 13'49
No
COUNTY AUDITO
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,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 contract buyer of the afursanentioned property on date application is filed.
Pr(owner's full name) Date(month,day,year)
of appl ant(number and strecejt city,state,and ZIP code)
rrn-FcrCt . PO.goA 105 h-Arcmicco -rm `{7 GL 9
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)