HomeMy WebLinkAboutMortgage_Schmitt (9)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
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FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R71 / 6-09) ��
�' w. I Presaibed M DePertment of L.aal Govemrtreni France
�i JL _�.J " INar1c9
1STRUCTIONS:
.8 be lled in person w 6y mail with the CounryAuditor or Counry RemNer o! fhe counry where the property is �.� �
Filirg Dates: 1 J Real Pmperfy: Musf file durrzg the yearlo� which the deduction is sought.
2) Mobile / Manulactured Homes rrot assessed as Real Property: Must file dunng the fweNe (12) moa`hs� �
6efore Ma2h 31 of each year fhe deduclion is sought.
See reverse side /or additional instruclions and qual�cations.
t(owneroroontrarl buyer -� resvirabrtt on 2verse side)
a OistrxY K rnmfber / kgal desai6tion
� o�b-1 - 3 - 30'
MsrsseE rah�e d real V WMY az d Mortgage / ContrarY iMebted�ss
Ma�M 1. anan yex Mard� t. wrrent year
tt ro, what a ha / her e�d share ot intemst?
name on rcco�tl s Eiflemn� Nan Nat ol appGCan;
Name of mwtgagee ar crntract seller
Address of rtnrtgagee a cantraa se0er
Name ot assignee w oNer owner ar hdAer ot nnrtgage
crly, sfate, aM ZIP code)
Mdmss of assignce (number arM st2e4 �1: s+ae, aM ZlP code)
own peoperty in any oUer
- 000. a, ,l$ -
paid as W Mongage / Cmtrac
Cate oi app�ption
tl owned v.iN sortieone atfwl
U CounryAuditor
� Counry Recorder
r�
�-
nha Page number
D i � �
4 Is Ne ep�t Ne sde
legal w e7uitaCle v.meY.+
❑ Yes ❑ No
spause. ind�imte ritli �N�mn
Is Ne V�P�Y in Vunstion: MfweOy AssuseC
❑ Reai afoperty ❑ nnn�wya�se�ed
Dra���er 1\fO...�IOI CT.......
Card NO. ..... �g.�.........
pt� 13 �'1 !� ,807, �
couNrrnuorzoR
oee� avv�a m ure ��c ar.
zo zo zo zo zo zo 20
s4,nawa a can,H a,art« camy oate c,�,�m, mY ,�n
C,
I I We certify under the penalry of perjury t the above a oregoing intortnaUOn is true and cortea and Ihat the appli�ant is a resident of Intliana aM
owner I contract buyer of Ne aforementioned property ate application is filed.
� Sig� neme Date (morvh. CaY. Yaa�
�--
full revtlem atltlress ol apppfirant (num�er antl strcef, tlry, stafe, a/wl ZIP mIe)� /� y7d 3
�OI 5. /lac� S-f- czu:�q�ait
Person authorired by CW/ eseated Power o( AUVney or by IC G7.1-12-0.7 Date (mMlh, Eay, yae�
MEress of a Wmrvetl persan (num0er aM strce{ c4y, sate. anC ZlPCOtle)