HomeMy WebLinkAboutMortgage_Schurmeier (3)�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` � Siale Form 43709 (R4 / 10-07) �/�
PrescribeA by Department of Local Govemment Finance j
� �`�,
INSTRUCTIONS: � File Mark
To be (led in person or by mail with the County Auditor o( the county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months beloie May 11 0/ the year the deduction is to 6e e(/ective.
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 3f of the year the deduction is to be e!lective.
See reverse side for additional instructions and qualifica6ons.
Applicant (owner contrdct buye - ee 2stri ' on reverse ide) '
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Taxin Distrid Key nu r/ legal description Record number
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0 % /n�Q .D _ ` Page number
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Ass ssed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the a nt the sole legal or equitable
March 1, current year March 1, current year , ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erenf than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane (IC 6-1.1-�
' me of mortgagee or contrad seller r
✓
Address of mortgagee or conVact seller (number and street, a, tate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county7 What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for current yeaf? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
zo Zo zo zo D 5 Zo � b 20 � zo ��
1 � � � / P
Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ignature (owners full na Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull sident address of applicant Address of authorized person
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