HomeMy WebLinkAboutMortgage_Schmits (4)�e��p t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f FOR DEDUCTION FROM ASSESSED VALUATION Coun Tormship Year
��� / State fwm 43709 (R6 / 5-06) � " � " � �
M� Presaibed by Department of Loral Govemmem Finance �
INSTRUCTIONS: NUV `L �����
To be liled in person or by mail with the County Audito� o( the counfy where the p�operty is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 months before June Il of the year the deduction is to be effective.
2) Mo6rle Homes assessed unde� IC 6=1.1-7: Between January 15 and March 2 of the year t�E��idto 6e effective.
U
See reverse side (or additional instiuctions and qualiTcations. GIBSON COUNTY AUDITOR
Applicant (owner or conhact bu r- see restrictions on reverse side) •
Tauing Distrid . Key number / legai description Record number �� n
/'� r
`,�/Y� �7(a-1,3-,�-.�Q7 -C�O. �3 �o "� y Page number / 8 0�- /
Y�
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applica t t sole legal or equitable
March 1, cunent year March 1, current year ownef? ' Yes ❑ No
..��D�U
I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is difterent than that of applicant, indicate below: Is the property n queslion:
eal Property ❑ Mobile Home QC 61.1-�
e of mortgagee or conVad seller � �
� - La s
Address of moRgagee or conVad seller (number and st2et, city, state, ZIP ., _�--
Nama o1 assignee or other owner or holder of mortgage a�
8�:..1.r�....
Drawer NO.. .
Address of assignee (number and street, city, state, ZIP code) �
CardNO.. ���fi�.'.....
Dces appfxant own property in any other If yes, what county? C� e g�•J �U been requested on
county in Indiana? �b� �,.! ��"/ �_ _�_,,, ,,,, wrrem yeaR �] YesO No
COUNTY AUDITOR
Dedudion approved in the amouni of:
20 _Qg 20 � 2/ 20 20 20 20
P P I�
Signature County Auditor Date
We ceAiy under lhe penalty of perjury that the above and foregoing infortnation is true and corred and lhai the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
lSignature (owners full name) Person authorized by duly executed Power of Atlomey
\ ��� �� or by IC 6-1.1-12-.07
Full resident raddress of applicant (� /�y Address of authorized person
�yg $ .J %� D L�j �/Dd�rLcats C�?L- L%%�' %