HomeMy WebLinkAboutMortgage_Schultheis (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION ��' n'�' Couri ' Lt1� Township Year
S,w• / Sute Fwm 43709 (R5/4-03) � �� N�
� PrasaiDetl by Depariment of Local Govemment Finance Y
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INSTRUCTIONS: � r �j File Fitark
To be filed in person or by mail with the CountyAuditor of the county wbere fhe propeRyjs./ocated.�; J�7����
Filing Dates: 1) Real Property: Dunng fhe 12 months befo2 May 11 01 the year the deducfion�is.to�be;efrecfive.:T�"
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tAe deduction is to be eNective.
See reverse side /or addi[ional instructions and qualifications.
Applicant (ownero contract buyer- see 2stri ' ns o rev rse side)
Taxing Districl Key number / legal description Record number
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Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the ole leg I or equitable
March 1, currenl year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan Ihaf of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contract seller �I
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year?Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 �� 20 �� 20 �_ 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
Signature (owners full name Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07 .
f I resident address of applicant Address of authorized person
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