HomeMy WebLinkAboutMortgage_Kiesel (7) �. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county hi gE
- t FOR DEDUCTION FROM ASSESSED VALUATION + �l
State Forth 43709(R73l 10.75) �s
"---• Prescribed by Department of Local Government Finance
INSTRUMONS:
FQh rhtalt5 2017
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 Author or County Recorder of the county where the prope /,sS ON C Auditor
located on or before January 5 of the irmnediatey succeeding calendar year. �l�outftJdidtlr
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Marco 3f death year the deduction is sought
See reverse side for additional instructions and qualifications.
App&rant(owner or contract buyer-see resific0ars on reverse side) ,
-x 00_7 ./x.37 Jll V P-f t ,.
Key number/legal description Record number
Page number
n 1r-rt7 .210 - 2 b3- So ;19 5=n� c b l`I 3181
value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage
- �- Teed date,current year assessment date,current year p of application ebtedn unpaid as of legal or�e owner?
R (0% d/Yes ❑ No
If no,what is his r her exact share of interest? J If wined with someone other than spouse.indcate with whom `'�
If name on record is different than that of applicant•indicate below: ,II,ss sL.th�ee pro''''perty in question:Annually Assessed
Ly�ea)Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or.• tract seller
• al 1 .,
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Address of mortgagee• •• •-•seller(number and street city,state,and ZIP code)
Nacre of assignee or other owner or holder of mortgage (�
\ Ol
.
Address of assignee(number and street city,,state,end ZIP code) Draw el O•..`/^/.t ..(lX.)�l/• . .
Does applicant own property in any If yes,what county? What Taxing District? ...(
.. '• •••••. 3n
Indiana?other county in ❑ �
Yes Ito Card \ . ..;.
• A person is not entitled to this deduction unless the person has a balance on the person': ...,,...emress that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county re, a once)that is the basis for the deduction.
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/We certify under the penalty of perjury that the above and foregoing informations 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.
S' (owner's fue name) Date(uiv..th•day,year)
Full dress of applica
nt(number and Sleet illy, and ZIP code)
{aTairN ed by duty executed oPOwer gb b -`1'-1- Date(month,day,Yeah
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can indude imprisonment up to two and a half years and a fine not to exceed$10,000.
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