HomeMy WebLinkAboutMortgage_Schmitt`° �"" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S % State Form a37os (Ra / t0-0t) _ , �
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PrescribeC by Department of Local Govemment Finance 'y�� �?"1
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INSTRUCTIONS: F E �ile Ma�003
To be filed in person or by mail wifh the County Auditor o( the county wheie the properiy is located. i 1
Filing Dates: 1) Real Property: During the 12 months belore May 11 0l the year fhe deduction is to be e ect�ve. �
2) Mo6ile Homes assessed under � 6-1.1-7: Between January 15 and March 31 0/ the y r the deduc ion �ia to be e11ec e.
See reverse side loradditional instructions and ualificaGons. GBSON O�U�� .4UOITOR .
Applicant (o r rcontract yer- see 2stri n n�ver e ide)
Tauing Distrid Key number / legal description Record number Q�
�/yj� J/'�/� ac v� yry� Page number
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Assessed value oi real property as of Mortgage / Contrad indebtednes;,unp d of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year ��`�� ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? f owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicant, indicate below: Is the properiy in question:
❑ Real Property ❑ Mobile Horrie pC 61.1-�
me of mortgagee or contract seller
Address of mortgagee or contrad seller (number and �eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
� \ COUNTY AUDITOR
Deduction approved in the amount of:
20 Q,� 20 8� 20 20 20 20 20 0
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Signature County Audilor Date
'/ We certify under lhe penalty of perjury lhat the above and foregoing infortnation is true and corred and that lhe applicants was / were
reside of Indiana and owner of the aforementioned property on March 1, 20
� Sign (owner /ull ame) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fu resident ad ess of appliqnt Address of authorized person
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