HomeMy WebLinkAboutMortgage_Schmitt (5)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o Year
+ FOR DEDUCTION FROM ASSESSED VALUATION
•r`_'.. • State Fwm 43709 (R71 / 6-09)
, t p�mp� py DeP��nt of Laal Govemment Frence
�TRUCTIONS: � MAY 3 �C'�f1�a`�`
Fortn f�ed with:
To be filed in person w by maii with the CountyAUditw or Counry Recorder o/ the couniy wl�ere [he property is located.�
Fd'mg Dates: i) Real Pmperty: Must fi)e dunng the year for which the deduclion is sought. � Counry Auditor
2) Mobile /Manufactured Homes irot assessed as Real Property Musf file dunng the hvelve (72) months
6eforeMarch37oteachyearNedeductionissought. GIBSONCOU TY D �'Recorder
See 2verse side for additional instiucdons and qualilcations.
AodioW (owneror contrarl buyer - see iesbictiol}s rn reverse side)
It �a.
Key nun6el / lega esaiDtion Rttortl iwmber Pa9e number
� _ 3_ 300-000. s�a -oa ia oao
f real popertY as d Rbrtpa6e / ContraG indebteOness unpaid as W Matqa9e I Contraa'uNe6tetlness unPaW as d Is Ne ePd��t Ne sde
yrar Mam}� 1. n�rtent yeer date of app�tatim �al w eWitade o�me(.+
a 3 ❑ Yes ❑ No
/ tcer exaG share of interest? If ovrtreC wiN sameone oMer Man pouse, indkate with wtrom
«� reare �s amere�� ma� u,a� or zva��. maka� ceww
w mm9agee ar oono-aa
AddRSS of mortgagce w contraG sWer
Name o( a5si9nee w mher owner ar hdder at mwtga9e
applicant own property in any aher
y in Indena? ❑ Y2s �
rbpn appmved'v� Ihe amouN of.
20 20 _
Sig�aNre d
state.
5f3te, arttl [lY COtle)
F 3y-3_
11 yes. what munry/7
I No
cou
20 20
I/ We certify under the penalyGf perjury that
owner I conVact buyer of �he afo2mentloned
)n3tlue (ownefs NO name)
SCN MAT p(�R.�-'*� T
�ZAi3�1�+ M
3S?��
Wtat Tarirg Dislrict7
n auorrott
_ 20 _
Caunry
l�-/oao
� ���� �, ���� �, o�
fOf°�� (� Yes ❑ NO
20 _ � 2� _
�Y•Y��
above and foregoing infortnation is We and cortec[ arM iha[ Me appli�ant is a resident of Inda� aM
�erty on date application is filed.
Date (monfi, dey, yea�
Full resident(itld�ess of appfitant (numtier�nE sheel. tlry state,
.3 a 5 0 l�/ l u Sz� S 2Lct�
Pe�snn autho�aetl W dWv �ecvteA Pm�er W AtlomeY or by IC 1
of autha'ved perswi (number antl svee4 dry, state, antl ZIP tode)
r e✓ 4--r 6
o�e �,�,�, ear.