HomeMy WebLinkAboutMortgage_Kissel (2) ,04.- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Fc FOR DEDUCTION FROM ASSESSED VALUATION A
1 Y State Form 43709(RU/6-09) ('
-'/y Presrnbed by Department of Lad Government Finance �Xl
ark
INSTRUCTIONS:
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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 sotAhr.AUditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months C U/QR
before March 31 of each year the deduction is sought - ❑ County ecerder
See reverse •e for additional instructions and qualifications. Q/QS
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Appgcent or.. .boyar...- mrere .e)
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R•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the applicant the sole
1'current year March 1,cement year data of application legal or equitable owner?
Iff ❑ 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 the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(ICS-1.1-7)
Name of mortgagee or contract seller ��
Address of mortgagee or contract seller(number and 4 city:stare,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,mate,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? -_ i1. - for anent year? ❑ Yes
❑ No
Deduction approved in the a I lertilide212 K
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it 7.5
Signahue of Cwmty Atrddr � / r /20 20 lb/4 - [ / (month,day,year)
I I We certify under the penalty of perjury that the above and foregoing informuuo•,.y 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.
X wnSig re(owner's foil name Date(month,day,year)
x II 115/14
Full resident address of applicant(number and street cal:state,and ZIP rode)
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Person authorized by duty executed Power of Niamey 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) .