HomeMy WebLinkAboutMortgage_Kihn ,. a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E } FOR DEDUCTION FROM ASSESSED VALUATION
State Fero 43709 D(R13/1415)
• Presalbed by Department of Local Government Finance
FILE
INSTRUCTIONS:
To be filed in person or by marl. - Fo'infill with
Ring Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought MAY 2 4
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ug 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 ceu a - i• ,K. -ecerder
where the property is located during the twelve(12)months before March 31 of each year the deduction is-• r 1.:. -" y>
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Appfcant(owner or contract buyer-see restrictions on reverse side)
N Lno-4 4 7,1-q2,"-}
T . Key number I legal description Record number Page number
A& - /9 -.3a -/% - .000.. 7/ S-oaV ?-o11 1971
value of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,currant year assessment date,arrant year date of application legal or equitable owner?1 0 8f 7 L3 ❑ Yes 1:I No
If no,what is his I her exact share of interest? •- K owned with someone other than spouse,mdcate with whom
If name on record is afferent than that of applicant,indicate below - Is the in question:Annually Assessed
Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller (.- ct.t . K 1
Address of mortgagee or contract seller(number and street a1y,state,and ZIP rode,) `'•`,/ r`°,/
Name of assignee or other omer or holder of mortgage V )o gj( ?
Address of assignee and ay,state and ZfP code)
0 f
Does applicant own property in any If yes,what county? N1at Taxing District? Has 1 •••.
in
other Indiana?ty ❑Yes ❑No on
d y^
A person is not entitled to this deduction unless the person has a balance on the person's mo C a l'd IN O ../ l unty
recorders office(including any home equity line of credit that is recorded in the county recorcc•.. ..... '' ••••••••.(.
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20 20_ 20 20
Signature of County Auditor County • Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
ownerkefantract buyer of the aforementioned property date application is filed.
Siu -, . //r-' ,fufi. •e Date(n d.,day,year)
\ F app a� e
/ 5 6. 6 e G.and
/4 $7b n
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(moth,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for penury can include imprisonment up to My and a half years and a fine not to exceed$10,000. -
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