HomeMy WebLinkAboutMortgage_Krieg (4) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
r .,9 FOR DEDUCTION FROM ASSESSED VALUATION ��
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'� State From 43709(R73l70-75)
Prescnbed by Department of Local Government Finance ��_
i���7,!17g)
INSTRUCTIONS: I l i • :�l1S'
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 the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county when the pro 4 5 2 110 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 County Auditor of the county County Recorder
where the property is located during the twehe(12)months before March 31 of each;earths '41 . .rr,�
See reverse side for additional instructions and qualifications. W. .l rm10.
Appriant(owner ot buyer restictions7re rse side) • bIt3SON COUNTY AUDITOR
Taxing District Key /legal Record number Page number
- DO-00o. 8a�r oo� i 93
1
Assessed value
da , real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the or equitable the sole
assessment data,current year assessment date,current year date of application legal or equitable owner?
lg)raro 0 Yes 0 No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom -
If name on record is different than that of applrnt indicate below: Is the property in question Annually Assessed
0 El thizisidn 40044-4-- Real Property I: AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
Address of mortgagee or '
Name of assignee or o
Address of assignee(nun
CAOCkaeCit,_IcTi -CI
Does applicant ova p been requested If yes,state amount of deduction
other county
in Indiana? ❑Yes �J Yes CI No
A person is not entitled ct indebtedness that is recorded in the county
recorder's office(indu I at is the basis for the deduction.
Deduction approved in QUIClei �r.J_�.,L_!20 2 \ 20 20
Signature of County Audi C j �� Date(month,day,year) •
I I We certify under nil that the applicant is a resident of Indiana and
owner/contract b /V�/� a,
Signature fuanar_ �' Lt� Date(month,day,year)
F a ress 7-C
Per3gn authorized by duty1 1 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$10,000.