HomeMy WebLinkAboutMortgage_Schurter� "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6-09)
S w. J P�esaibed M �epartrreM of Lo�l Govemmenl Fnance
Fiie Mark
wsrRUCnoNS:
To 6e filed in person or 6y mail with fhe CountyAud'ROr o� Counry Recorder o/ the wunry whele the property is located.
Filing Dafes: 1J Real Property: Must file dunng the year lor which the deduction is sought.
2) Mo6ife / Manu/actured Homes not assessed as Real Property: Must file d�nng the tweNe (72) months
before March 31 01 each year the deduction is sought.
See ieverse side for additional insWUbns and qualifications. �
Appfuant (owner or mnMact 6N'zr- see res�{ctions mgrerse siCe1 ._ ./f ,. i w ^ w
Counry Auditor
T�ay�g DistriC Key num6er / ieyai aesmptian �d numDer Page numbef /
/' a�- 3-�i -aoo-oDo, 9�5 -oo� �Oa9 3 �
As�sed va4m dreal property az d Mortgage / Contraa indehtedness unpaid as of htorlgage I Con� iMebteEness unpaiO as d Is the appfi�nt Ihe sde
I�1arch 1. arrent year Mamh 1. wrtent yeer Cate of appGCation legal or eQUitade wmeY?
❑ Yes ❑ No
n �o, �rt,�� �s n�s r ne� �ua snare or �ne�n If awned vrith someone W�er Ihan spouse. indinte wrth whom
tt reme m remrE's dAtemni Nan ihat of aPp6rani, 6Wicate bebw: . • Is IM pmperty in Quesfion: MnuaAy AssKted
. . ❑ Real ProPenY ❑ ���Y � . _
Nartre of mortgagee «mntraa
IrJ'�.'.t...�.Y.^.,_:t . �
Name M assignee or othei owner or halder of rtartgage
ray. ffim, aM Z!P codej
PdCress ot assignee (numeer end stree; ary, stere, arM z�P coee)
ooes eppifanc ov.,� v�o�r
munryinlndana? r
of.
� I �
1 I We certfy �fWer ihe penalry of
owner I contrad buyer ot the afon
7(awre(o� iers7wname
� �
tll resiEent address ot appfcant (numbe
3�� �{/ /05��
r5on auNOiaetl Gy dWy eaecuted Pw•'
Idress of ainhor'ved per,on (numbers
�mr I wi
zo _ � zo
Drawer NO.. c�l'�.,O.�I........
Card 10. ....�y1S.......... ,�
�n�.�.mc� ❑ No
—� W v
p_ � �_
Date (monM, day, year)
2I1 _
that the above and foregoing infortnalion is W e and cwre�t and Nat Ne aOP���nt is a resideni of Indiana aM
�ned properry on date applicatlon is fited.
Date (monM, daY. Yaa�1
an0 sLee4 �Y• state.
sbeet, dry. state, aiM ZIP code)