HomeMy WebLinkAboutMortgage_Kifer (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coup shi Year
FOR DEDUCTION FROM ASSESSED VALUATION Ty � D
- - state Farm 43709(R71/sag)
Presaibed by Department of Local Government Finance
F
Ise Mark
INSTRUCTIONS: me . • I
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought ❑ .un Auditor•
2)Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)mo9(hs t/ �--a.
before March 31 of each year the deductions sought �BSO en�;7q` Recorder
I
See reverse • for additional instructions and qualifications. • • OR
1
App6eaN a.. ... an
Ta: . .'., . Key / d Lion Record number Page
!40— art o-,ov - coo.0�S9-o�� do/cc 7 o
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage l Conaacl indebtedness unpaid as of Is the apprt nt the sole
Mardi 1;anent year Marti ,arrtent year date of a legal a equitable owner?
1/4.4667.), dOQ ❑ Yes ❑ No
If no,what is h's I her exact sham of interest? If owned with someone other than space,indicate with whom
If name on record is dtfenwd than that of appl a n,indicate below: Is property in question:Annually Assessed
Real Property ❑AnnuallyAssessed
• /7 q Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seder
/ell— I / ( q C/Address of mortgagee or contract seller(nrmibercreet,{city stare. ZIP code) /V.�//w/A`
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Dces applicant awn property in any other If yes,what county? • What Taxing District? Has this deduction been requested an property
county in Indiana? for year?current yea
❑ No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of: •
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 aforementioned property on date application is filed.
SlgnaN V it name) / ' -Date(month,day,year)
y 07" . G/ .4. l/ , .i- / -••••ti ha- Adile
Person authorized by duly exeaited•• it of Attorney or by IC 6-1.1- -0.7 -- (Date(month,day,year)
Address of authorized person (number and street city:state,and ZIP code) .