HomeMy WebLinkAboutMortgage_Kiesel (3) aa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
Sea Form 43 (R131 10-15) •
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Presaed by Deparpar trnent of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mall ����/ � Form filed
fling Dates: 1) Real Property:Must be completed and dated in the calendar year for which the digaioNis sotW
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the g'; _ y,/ ,,'i a county 111 County Recorder
the property is located during the twelve(12)months before Mardr y � I c '17'7 f. ITO •
See reverse side for//:..Atonal instructions and qualifications. !J�///�,/� �//J
Applxant(owner. %l•- buyer-see ti'side) �`/ •
T. ! , . page
III . t ° 02- n,3b o -coo• 7&,9—Oay `�6 9
:�value heal popery as of Mortgage/Contract indebtedness unpaid as of - Mortgage/CoMma indebtedness unpaid as of Is the applicant the sole
--- date,aarerd year
assessment dat{p..���t year`�� date of application legal or equitable owner?
/ wW ❑ Yes ❑ No
If no,what S his/her exact share of interest? if owned with someone otter 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
Me Nome(IC 6-1.1-7)
Name of mortgagee or contract per 5 3
Address of mortgagee or contract seller(number and street,d4' e,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street,my:state,and ZIP code) •
•
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Does applicant own property in any If yes,what county? . What Taxing District? lias ties deducrbn been requested If yes,sate amount of deduction
other county in Indiana? ❑Yes ❑No - current year? ❑Yes Li No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(inducing any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR • - •
Deduction approved in the amount of
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20 f 20 __.1__ 2(1 I p 20 1 20 20 20
&ignanme of 69 — / Date(month,day, .
if e certify under the pe -ty of pF D r a NY r NO I correct and that the applicant is a resident of Indiana and
owner f contract buyer of the aforen
Appure Br's ruff name) Date(month,day,year)
. to- P. Card NO.
pofipident address& ppla licant(numberF
J)fl6-7 Sr 9 51 c�yr/ n• j /v, � / (eta
Person authorized by duly executed Power of Attorney 6r by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street,aTy,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.