HomeMy WebLinkAboutMortgage_Kruse (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. .% FOR DEDUCTION FROM ASSESSED VALUATION
ts ,i State Form 43709(R13/10-15)
e :.
,,,, Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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 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 Property: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 for additional instructions end qualifications.
Applicant owner or contract buyer-see restrictions on reverse side)4
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CLSOrN �1- S Glx-C-y--1 Yam,-�-��A
n.District Key number/legal description Record nu r e number
V \%ILO__1 tin. 0'4-e9S - . 5q k Oaz -20 to P4
Assessed value of real property as of [Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedneapvpaid as of Is the applicant the sole-
assessment date,current year assessment date,current year d e of application legal or equihab owner?
Gg AP es 0 No
If no,what is his/her exact share of interest? If owned with someone other tan spouse,indicate with whom
if name on record is different than that of applicart,indicate below: Is the perty in question:Annually Assessed
eaI Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name mortggagee or contracts ller (_y
V �`��, vim. _
Address of mortgagee or contract seller(number and street city,state,and ZIP code) !R'
Name of assignee or other owner or holder of mortgage
o> 6 / q — '7iSZ - 9.% Vp19
Address of assignee(number and street,city,state,and ZiP Q�
Does applicant own property in any If yes,what county? Drawer NO been requested 1�[tnetluOcRort
other county
in Indiana? ❑Yes El No ]Yes 0 No GOVN
A person is not entitled to this deduction unless the pe ',tract inddbess that is recorded in the county
recorder's office(including any home equity'line of cre Card N O. rat is the basis for the deduction.
1 ' ','JI.e r tWIJI I VPc
Deduction approved in the amount of:
i
20 20 20 20 20 ' 20` 20
Signs r of County Auditor C unty Date month,day,yea
. � )tea \C( 2. -I
I/We certify under the penalty of perjurythat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own /contract buyer of the aforementioned property on date application is filed.
Signatu Owner's full name) Date(month,day,ye ,
/��/ AcaL. 1 - �-1
Full resider t address of applica (number and street,city,state,and ZIP cod
Person authorized by duly execute Power of Attorney or by IC 6-1.1-12E0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for ne►iury can include imprisonment uo to two and a half vears and a fine not to exceed sin non_