HomeMy WebLinkAboutMortgage_Kitchene �s,�• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E'" ., FOR DEDUCTION FROM ASSESSED VALUATION �I(�
. ^` State Form 43709(RI3/t0.t 5) 1 A�„c,. �' y,Y C\CA
S il" Presarbed by Department of Local Government Finance �!�It�`1 N 1 11 11 V l U •
INSTRUCTIONS: File Mark V
)b be filed in person or by mail F rm fi ed 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 where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side f�or^additional instructions and qualifications.
r)") fi n�eS Key District mber\-� .2 �— . nber 546r
)t ,�d�p�J ��l 3B — �
assessmentAssessed o real p year of I Co indebtedness assessment date,current unpaid as of MortgagerofCorrtact indebtedness unpaid as of . Is the ac egiim a sner
d a r t: TU 10 S`-•rr E,] Yes 0 No
If no,what is his/her exact share of bus ? If owned with Bone other Ulan spouse,indicate with whom / \
If number--- _..._ __.._. __. __ ,.� - 1s16e property in question:Annually Assessed
(J�y,dU_�°`I ' [y],Real Property 0 Annually Assessed
1._. 7\ Mobile Horne(IC 6-l.1-7)
Name of I y ` A
Drawer NO °2o �` (i ``,.:
Address silt) 3 ZIP ..-) (I ---.1 .
Name of Card NO- DEC 21 tuiS
Address•-.___.a..__,.._...___.____.',_.,. ..._... .....,,. fi .
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Does applicant own property in any If yes,what county? What NWT.jsbk'42 UU l''I Has tart dediicaon been requested If yes,state amount of deduction
oint rioun7 ❑Yes ❑No anent�? ❑Yes ElNo
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(including 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 20 20 20 20 • 20' 20
Signature of County Auditor County - Date(month,day,year)
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I/We certify under the penalty of perjury that the above and foregoing information is 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.
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Date month,day,year)
oki
` s pf applicant(number and s�eet aty stare,and ZIP cods
Person authorized by duly executed Power oMAttomey or by IC 6-1.1-i 2-0.7 " 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 310,000.