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HomeMy WebLinkAboutMortgage_Kasinger (2) s' �"a_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�fllte.ip eh, ear FOR DEDUCTION FROM ASSESSED VALUATION II ,- .; GoeState form 43709(R11/649) Prescribed by Department of Local Government Finance JUEle1Madj014 INSTRUCTIONS: b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with: Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 'I/ ,; , ditor 2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months I;i�, Pr uamcrf�r before March31 of each year the deduction is sought GIBSO C.1 1ernlUrrj See reverse side for additional instructions and qualifications. Appfioan or contract buyer-see resuictbns on reverse side) e Q�s1 c-a) L.' rg ct Key numbj/legal description Record number Page number o �7 ac, . iu- 15 - ID'b - ©oy_ osi - a.z7 Q.r)ttl 1.50(0 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact rode ess unpaid as of Is the apt:Wsant the sole March I,content year March 1,current year �� date of applcation legal of equbade O es d no,what S his/her exact share of interest? pt�J`� If owned with someone other than spouse,indicate with whom t\t�7,T, If name on record is different than that of applicant,indicate below- the property in question:Annually Assessed 'Weal Property! ❑Annually Assessed ' Mobile Home(IC 6-1.1-7) - Name of mortgagee or contract seller 5 4 r� • Address mortgagee or contract seller(number and street,city,state,and ZIP code) • • • Name of assignee or other owner or holder of mortgage 1�, Address of assignee(number and street,city state,and ZIP cede) r g.Le.••'. Does applicant own property in any other If yes,what county? - What Taxing" �Q• \ td an property county in Indiana? ` 16 ❑ Yes FNo G1 J Yes 1,11. o - COUNTY AUDI. 49. moo. • Deduction approved N the amount of: al 20 20 20 20 20 20 Signature of County Auditor • County Date(month,day,)ear) 11 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. nature(owner's full ngme) Date(month,day,year) ....wv p.�l)t� resident address of appli ant( ben and street,city state,and ZIP code) 'k3 ) I (Ja4 re)asv Qohlptt)rti Dr. (i)c:es.aa-4-or =�/1/. 1417 7C7 arson authorized by duty executed Power of Ammer 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) .