HomeMy WebLinkAboutMortgage_Krueger '"'".a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township 1 Year
;e,-_ = FOR DEDUCTION FROM ASSESSED VALUATION
'' State Form 43709(R12/6-14)
FILED
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i'� Prescribed by Department of Local Government Finance 1 tl J�
INSTRUCTIONS: YR File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which phEppdpolliflought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where he property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with&r- Ceun;A 4): • e county
where the property is located during the twelve(12)months before March 31 , .1 i- Si '/'-C7aa -duction is sought.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or c t c uyer-see res!nc verse sidieo)p ` ^ -
7 in '•-Qct Ke`y-•/o r/legal descn��^/_L^l/_4�� oo ��s d n tuber /y/^(PJa,eL(3nu�mllJ�ber
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,coag.L.year date of application legal or equitable owner?
DOD ❑ Yes ❑ No
If no,what is his/her exact share of interest? I 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(IC 6-1.1-7)
Name of mortgagee or contract seller O 1 (\\ t
Address of mortgagee or contract seller(number and street,city,state,andsZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? I What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county I on property for
in Indiana?_❑YP_a-- n^r^ current year? ❑Yes ❑No
A pen ` CO R j-S T�/ m' 3 balance on the person's mortgage or contract indebtedness that is recorded in the county
retort DA IO N �1 n I recorded in the county recorder's office)that is the basis for the deduction.
Deduc (� ��-Gt. I�t Cm IS5Ty COUNTY AUDITOR
2. K2uEG��2., C 4137X pi-gam-
I (o— JlY z/ - 20 20 20 20
Signets 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.
i naP re wners le name 1 ►` ' Date(month,day,year)
9 ) RR II ,, '' nn nn��
J{ll state,a
all rest ent a dress of scant(number an tre city,state,an ZIP e) I 4 7404 si
' 12. E '145 av►eh
Person authorized by duly executed Power of Attorney 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.