HomeMy WebLinkAboutMortgage_Schmitt (8)��.� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
`� FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
State Forrt; a3709 (RS / 4-03)
PrescnOed Oy Department of Loral Govemment Finance .��� �� ,,,_..9 ��
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditor of the county where the property is located. 5E�' �.� Z�03
Filing Dates: 1) Real Property: During the 72 months before May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o%e ye�duUion is � 6e affective.
See reverse side for additional instructions and qualifrcations. ��' ��
- � CiBSON CvU� ?Y AUDITGR .
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see
f value of real property as of
current year
Ii no, what is his / her exact share of interest?
side)
Key nu�ifer/legaldescription
oo�-ooa6,
Mortgage / ConUact indebtedn
March 1, current year
IJOeI/✓✓
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Record numb
Page number
unpaid as of a Is the ap
� owneR
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e sole legal or equitable
Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
P��.me of moAgagee or contrad seller
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Address of moRgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
,lddress o( assignee (number and sfreet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing Dislrict?
county in Indiana?
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Signature
COUNTY AUDITOR
approved in the amount of:
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County Auditor
20 �
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Is the property in question:
❑ Real Property ❑ Mobile Home pC 67.
Has this dedudion been requested on
property for current year?� Yes❑ No
20
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20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
'esident of Indiana and owner of the aforementioned property on March t, 20
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
id�e�t adyjr�e�s �appl� nt IAddress of authorized person
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