HomeMy WebLinkAboutMortgage_SchmittlerQ rt�n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
'','°- : FOR DEDUCTION FROM ASSESSED VALUATION
S� y Siate FOfm 93709 (R4l 10.01)
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Presaibe0 Dy Departmenl of Local Govemment Finance
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INSTRUCTIONS: ' i File Mark'
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To be (led in person or by mail with fhe County Auditor o/ the county whe2 fhe property is located.
Filing Dates: 1) Real Property: During tbe 12 months 6e/o2 May 11 0l fhe year the deduction is to be e�ec�i� e.� �� � �
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and March 3i o/ the year tlie ded'ucfion�is to be elfective.
See reverse side for additional insWctions and qualifications. � �(� ��/ �
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orcontract
Taxing Distrid
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see restrictions on reverse side)
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Key number / legal description
Assessed value of real property as of
March 1, wrrent year
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Record number
n3-s
Q I I_ O O�,31 _O O Page number
Mortgage I Contrad indebtedness unpaid as of Is the ap�
March 1, wrrent year ownef?
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If no, what is his / her exacl share of interest7 If owned with someone other than
name on record is different lhan lhat of applicant,
❑ Real
ame of mortgagee or contrad seller
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Address o( r�rtgagee or contrad seller (number and street, Gty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street,
Does applicant own property in any
wunty in Indiana?
20 O T
P
Signature
approved in the amount of:
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sfate, ZIP code)
1 the sole legal or equitat
�Yes ❑ No
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in question:
N ❑ Mobile Home QC 67.1
If yes, what counry? What Taxing Distrid? Has this dedudion been requested or
property for current year? � Yes � N
COUNTY AUDITOR
20 �_ 20 �_ 20
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County Auditor
20 �
Date
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March t, 20
�resident address of applicant
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P@lSOn ButhOflzBtl by tluly 2xecuteo ruwei
or by IC 6-1J-12-.07
4.�b4 g Address of authorized person