HomeMy WebLinkAboutMortgage_Kruse (2) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION• � r
r �- Stale Form 43709(R13110.15) v1) �+ f 1.-�- 1 'O�„ Val
Prescribed by Department of Local Government Finance • v v�a+t
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form filed with:
Filing Oates 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 CountyAuddor or County Recorder of the county where the properly is L& County Auditor
located on or before January 5 of the immediately suoxeding calendar year. F;
2) Mobile I 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 twelve(12)months before March 31 of each year the deduction is sought
See reverse skis for additional instructions and qualifications.
Applicant pwner or con ct buyer- on to side)
Poi, r el--C v w k
Taxings District Key numb /legal description Record number tag number
���
2 ?t6-19-123- 2--ooD , 4 t 3 -O2.b , 2O�� 11
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid aspt Is the pplicant the sole
assessment date,=rent year assessment date,arrrent year date .(-•.h 3 ^ O legal o+egQitable owner?
Yes El No
If no,what is his/her exact share of interest? If owned with ne other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. e property in question:Annually Assessed
Real Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
a eMPO.n �"F IL ,
Address of mortgagee or contract seller( and street city,state,and ZIP code) 1 `
Name of assignee or other owner or holder of uuQyage MAY 15 z019
Address of assignee(number and street city,state,and ZIP code) T a f� {gyp
ifar
Does applicant own property in any If yes,what county? What Taxing District? Ha�reque5rar'ITR,E,state amount of deduction
other county on property for
in Indiana? Yes Elarn No ent year? ❑
AYes ❑No
A person is .i I;• to this did .... less the person has a balance on the person's mortyaye or contract indebtedness that is recorded in the county
recorder's.-' ..ding any horn equ fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
P c COUNTY AUDITOR
Deduction a.••tilt •� tot of:
20 204 '0 20 • 20 20' 20
Signature of County Auditor a(1 County Date(m des
I/We certifyunder the penaltyof perjurythat the above and tnoeAl�,b'^ S t
foregoing information is d correct and that the applicant is res' nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
re • Ngam , 1 _ Date year)
X �NI S �� q
Full add,ofa try aadsyeet dtr,state. Pcode)
40l.k VVi1 M�'4 �YI �� c cl+ - - 4 kcZ
Person authorized by duty executed Power ofAttonfey 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.- -