HomeMy WebLinkAboutMortgage_Schaefer (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
,_ _ s FOR DEDUCTION FROM ASSESSED VALUATION
. . � State Fwm 43709 (R71 / 609)
,,,,� 1 Prescribetl by Departmerd of Laal Govemmem Fumnce
File Mark
�STRUCTIONS � � � AI �� , ,
To be filed in person w by mail wi[h the CountyAUdifor or Counry Recorder o! the wunry where the property is bcated. 1Y 0
Filing Dates: 7J Real Pmperty: Must fJe durirg fhe }rear (or which the deductlon is soughf. C � Counry Auditor
2) Mo6de /Manuladured Homes iat assessed as Real PropeRy Must file durirrg fhe fweHe (12) months nty Recorder
befae March 31 0/ each year the deduction is sought.
SeereversesideforaddiGOnelinstructionsandqualifications. GIBSONC NTYAUDITOR
Apq"qant (owner � convact buyer' s�e 2s�fcbo�ts m reverse siCe) . n
Ta�dtg Distrip
-��1-1 -�x
i real qoperty as ol Mortgage / Contracl'u
year March 7, a�rent yeer
at a his / her e�oct sl�are of inte2st?
m remd is 6fluent tlun Nat o( aDP��4 rtMinie Eebw
Name oi mortgagce ar conttad
Mtlress of mort9a9ee w cantra
cily. stete. aM LP code)
Name of assignee w oNer owner or holder ot rmtgage
AdE2ss of asup�ce (nvmher and strce4 �dY. slafe, anO ZIP mde)
Oces appti�am w.n pmperty in any oNer If yes, what
munryinlMena? f"I .,__ 1"I .�_ .
I�!�IT.�^�1
(,J ' R¢cortl number Page number
a -o 0 3�
i as W Mongage / Contrac[ inde6teAness unpaid a d Is Ne appfxant Ihe sak
Eate of aPPtication kgal or ewiHde ovrtieR
❑ Yes ❑ No
rc awr�d witl, someone mM! than spasse, inaimte witl, wMn,
Is Ne popeny m Gurstim: Mn+a�Y Assesud
�v�r 0�'�
. Alodle Fbme (IC 61.1-�
vnai raA�y o�
COUNTYAUDROR
2p � 20 � 20 _ � 20 � 20
Dra�ti�er \�O. °7� ll..... ..
Card i\'O. ....�a�......
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Sigruture W CamtyAWitor I CauMY I Dete (mwdh. daY iP�
I/ We certify under ihe penalry of perjury Mat Ne above arW foregoing informalion is W e and cortect arM ihat Ne applipnt is a resident of IrMiare aM
owner / mntrad buyer of a(oremen0oned property an date application is filed.
�rigfaw (o h nn� name) _/ Date (monm. asr. raa�l
7erson autlrof¢eE Dy duty esE
Address of autha'ved person
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cilY. state. aM LPCOde)
Oate (rtxanfh, daY.
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