HomeMy WebLinkAboutMortgage_Krieg a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s County Township Year
_ Year
FOR DEDUCTION FROM ASSESSED VALUATION
f3 State Form 43709(R13/10-15)Prescribed b y y—F'I F ' 1) File Mark
Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. crn ������22nn Form filed :
Filing Oates 1) Real Properly Must be completed and dated in the calendar year for which the de n Is 7vt41ri8
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�A county ❑ County Recorder
where the properly is located during the twelve(12)months before March 31 of is sought
See reverse side for additional instructions and qua/Meat/ans. G I BSON COUNTY AUDITOR
Applicant(owner or conta� 9 anrse side)R
Tahgit)I Districp number 1 legal pfion.
0B--/9— $100 -007 O . 9 Record ri%r� P number
Assessed yaks of _real p as of Mwtga o �pinddiebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,anent year asse y r yeaab ^ date of apprxafion legal or equitable owner?
(((/L77/ �,yU l(,/) ❑ Yes 0 N
If no,what is his 1 her exact sham of interest? j If owned with someone other than cpvRn,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 1
/ /- -
I \
Address of mortgagee or contract seller(number and sbeet city,state,and ZIP code) - _
)y v1
Name of assignee or other owner or holder of mortgage Q.Z./y !\v, -o
ICI sN J
Address of assignee(number and sheet city,state,and LP code) Q� ( S O
• f� , • av 6,Pi
Does applicant own property in any If yes,what county? What Taxing District, l ) t� C .1f deduction
in Indiana? ❑Yes ❑No I J I' c,
A person is not entitled to this deduction unless the person has a balance on the person's mortgay_ j I led in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's officer_ h.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 r, 20
S. re• +'.. ..cyr L [/ , J// County 4 O Date(matth0?-/ C1-/6
Y
v f l
1/We certify under the penalty of perjury that the a jdregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ uyer of the aforemen• ed property on date application is Ned.
S natu nets NH name) Date(month,day,yeah
FW r of app hum and city,state,and LP code)
�.��4 q s s c. Fic. chsco, l� i69
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)
77he penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.