HomeMy WebLinkAboutMortgage_Kiesel .Fist?. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU I6 )
Prescribed by Department of Loral Government Finance
to
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
F 2014
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. fl County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months /1I''I
before March 31 of each year the deduction is sought - ./ 1 • nh
See reverse side for additional instructions and qualifications. r'IBSON COI INT 'AUDITOR
AppGrantjpwxr or contract buyer on use side) / •
Taring District.- Key number/legal description �(,K'•a--C-��� Record number P e nun
Lline�n—� a6- 19- o18 - aoo _ oo2. 33 . 0 / � (BItB
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract• indebtedness unpaid as of Is the applicant the sole
Mardi 1,amid year March 1,current year data of application legal or equitable owner?
54 o0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? r If owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home pC 6-I.1-7)
Name of mortgagee or contract seller - /7
Address of mortgagee or contract seller(number and street,city,state,and LP code)
Name of assignee or other owner or holder of mortgage
of assignee(number and street city,state,and ZIP code)
N NE '- - 1 - 10 3 . 07AG
Does applicant own property in any other If yes,what county? What Taring District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of --
j/
20 20 20 20 /K sit_ 8(2-0-1,} 41
ihiryvNy Gt)
Signs f COUmty Auditor Cour
/01\ — (0 G99
I/We certify under the pens of perjury that the above and foregoing infomtatio f� a and
owner I contract buyer of the aforementioned property on date application is filed. 7 S/Q 00(3
J/ Sign 9ii (r name) r_S sgee I Date(no un,wn r__.,ti At it(17124
Fug resident address of applicant(number and r,d ,state,and ZIP code) ��
17■, 5. a)ti 6 r-J� -
Person authorized by duly eseaited Power of Attorney or by IC 61.11--0.7 Date(month,day,year)
Address of authorized person (number and street oily,state,and LP code)