HomeMy WebLinkAboutMortgage_Schurmeier/ ��
:4—°•_ t
e,,\ •,;
�\
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fofm aJ709 (R4 I 10-01)
Prescnbed by Depanmenl of Local Govemment Finan[e
. . .
s : i
( 4 i t )�\
5_ i ;-.
INSTRUCTIONS: NpV l�e��
To be filed in person or by mail with the County Auditor o1 the county where (he property is loca(ed.
Filing Dates: 1) Real Property During the 12 monlhs betore May 71 0l the yearlhe deduction is to effective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ t ar t d c' is to e c(ive.
See reverse side /or additional instnictions and qualrfications. (31B$ON COII TY AUDIiOR
�r+ppucam �owner or contract buyer - see resMCtions on reverse side)
' _L �
b U (' `Y �' �
Taxing Distrid Key number / lega escription
, �Of!"�r/�'♦� (�W- l!/0/ yD!/!/ ��D�
Assessed value of real property as of Mortgage / Coniract indebtedness un
March 1, wrrent year March 1, current year
� 6D, oofi
no, what is his I her exact share of interest?
If name on record is
than that of applicant, indicate
of mortgagee or contract seller
Address o�
Name of assignee or
or contracl seller
as
Ftecortl number Q
�
rage number
Is the applicant the le legal or equitat
owner? es ❑ No
If owned wifh someone other than spouse, indicafe with v:hom.
and sveef, crty, state, LIY
• .. . 1 1
owner or holder bf mortgage
Address of assignee (numberand street, city, slate, ZIP code)
Is the property in
❑ Real Property ❑ Mobile Home 1
,
i
/
Cr1.1
Does app�icant own property in any other If yes, what county? What Taxing District? Has this deduction been requesied or
county in Indiana? � , property for current year7� Yes� N
vewcuon approveo in �ne amount ot:
20 _Q� 20 _Q� 20 Q�_
P
Signature
COUNTY AUDITOR
20 �_ 20
T
County Auditor
20
Date
20
I/ We certify under the penalty of perjury that the above and (oregoing information is true and correct and that the applicants was I were
a resident of Indiana and owner o( the aforementioned properfy on March 1, 20
Signature (owners lull � me)
�
Full re eni a ress ot applicant
� ... _ _ _ ._ .
Person authorized by duly executed Power of Atrorney
or by IC 6-7.1-12-.07
o( authorized person