HomeMy WebLinkAboutMortgage_Schmitt (4)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
..,_—..
: FOR DEDUCTION FROM ASSESSED VALUATION
� Sfata Fwm 43709 (R71 / 6-09)
S � Presaibed by Department of Lod Gavemrtrent Firence g
INSTRUCTIONS: pe
To be (led in person or 6y mail with the CountyAuditor or Counry Recorder of the oounry where the property is�tEB' �
Fiting Dates: 1) Real Pioperty: Must file dunng the }rear (or which the deducGon is soughf. � Counry Audimr
2) Mo6ile / ManulacNred Homes rrot assessed as Real Property: Muu ne dunng [he tweNe (72) mont�� L O'iiill Z County Remder
6efore Maich 37 0( each year the deduction is sought. � �N
See reversa side (oraddifional inshuctuns arM qualifications. C.�.
o»ne�arm�trect6uye�-seeresniceiwisonreverseside) A ` . . �� C
� I Key numbu / legel d/fvipti�n
a�- '�.� -oi -ioa -��.7�
pmp¢rty as of Mortgaga/ ContraG indehtetlness unpaid as of Mortgage / C
March 1, artent year date of appli
Iq. W�Id� 6 iC5 � iM! CY9f15�12f8 Oi IIIi2251�
rartie m ieard is tliRuent Nan Nat of aDP�4
Name al mart9a9ee «
Address of mort9agce w wntraci seAer (num6er and strae4 ��3'.
Name of assignee or W1ier avmer or hdder of mortgage
Add ot assignee (numDer aM stree4 �Y. �e, and
�
Oces appli�ant o+m poperty fn any oNer
munry in InQ'ura? ❑ Yes ❑ No
Orductian aDP�� H � amount
20 _ � 20
�� �/V/w�c�
aM ZIP cade)
Z'/P/OOtle) � /� �
T � �� '"r
If yes, what munry/? What Tariig District?
couNrrnuoROR
29 20 2
I/ We certify uMer ihe penalty ot �rjury Ihat ihe
e I o tr e buyer of [ e aforementio ed pr
Sign ( name
WI reside9�addre o a t num an sheel ry, 9
l� % O S ll
Puson auNORetl Gy 0uh/ exewced Pov.er of AttaneY or by
auNOr'¢sd person (num6eraMmeeL Wy, sta+e.
rtl m6er � Yege numb�
�y`��. a9v8
6tedness unpaid as o( is Ne appli�ant lhe soie
legal a eQuitaWe owneR
❑ Yes ❑ No
SDWSE. Illdlfdt¢ Wlfh MTWrtI
�5 IhC G��certy 1I1 QYCSf1IX1: iNM12� �
❑ Real ProPertY ❑ !vuival�Y Assessed . . _,
�./ [ .
Has N'a dMWion Eeen requested an property
���� ❑ Yes ❑ No
Sc;-ir� 3f�n�� y � __
r� 4�y �
�a�a�g
e and toregoing infortnatlon is We and cortect arM that the applinnt is a resaent or ina�a� arm
on date applicatlon is filed. .
oa� p�mm, ear.