HomeMy WebLinkAboutMortgage_Scheller (4)`O�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION un Townshi Year
S J State Fofm 43709 (R4 / 10.01)
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Prescribe0 by DepaMient W Local Govemment Finance
� APR 15 2002
INSTRUCTIONS: File ark
To be filed in person or by mail with the County Auditor of the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of e f��8�tl dd'nA5latiC�ie ective.
See reverse side lor additional instructions and qualifications.
Applicant (owner or contract 6uyer- see restnctions on reverse side)
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Taxing Distrid Key nu ber / legal description Record number 1
Page number
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Assesse alue of real properly as of Mo gage / Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, rrent year March 1, currenl year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
D Real Property ❑ Mobile Hane pC 61.1-�
� of mortgagee or contract seller
Addre s of mortgagee or contraIX seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing DistriU? Has this deduction been requested on
county in Indiana? property for current yea(? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Sign ure b" County Auditor Dale
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I/ We certify under the penalty of perjury that the above and (oregoing information is true and corred and thal ihe applicants was / were
-esident of Indiana and owner of the aforementioned property on March 1. 20
- Ignature (owners full name Person authorized by duly executed Power of Attomey
ar by IC 6-1.1-72-.07
Fu resident address of applicant Address of authorized person
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