HomeMy WebLinkAboutMortgage_Schmits (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
r. � State Fwm 437W (R71 / 6-09) EC 2 9 2011
�' ° PresaiOed Dy DepartmeM of Local Govemrtrent Frence
c.'�Fd"e��
�wsrnucnoNS:
Fortn fded witA:
To6efiledinpersonabymailwithUreCounryAUditororCounryRecorderofthecounrywherethepropertyislocate��BS C(2L;NTYAUDITOR
Filirrg Dates: 1) Real PmpeRy: Must file during the year (or which lhe deducfion is sought U Counry Audimr
2) Mo6de /Manufactured Homes not assessed as Real Property Musf Re during the fweHe (72) rtwnths
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for aCdifional insWctions and qualificafbns.
AppGCant(ownerarcmtraUbuyer-seere rerersevde) :
�
Tavrg Oistria Key rumber / legal CesaipUm Recortf rwmbel Page numbri
a�-, -�a- a��-� i.� -0 33, �
Atisessed ra4ie d real propaty as ot MoRgaqe 1 Contraq intle6teCness unpaitl as of Mortgage / Contrar2 "uWebtednrss unpaiG n d Is Ne app�innt the sole
Martii 1, anent year Mam3� 7,�alrtent year date of appLtatian legal or equttable vm�eY?
p �-[ � ❑ Yes ❑ No
If �ro, what is ha / her exaa share o1 interesY? If owned wiN wmeane ocher than spouse, iMicate with whom
It nartre m rem�d is ditfuen� ihan Nat of aPP�n; iMifate Gelmr. �Is..t,M/� property in QuesUon: MnuaDy Pss¢sed
� ){ Keal i'roPeRY ❑ ��Y �
T Modle Fbf� IC 61.1-7)
Name of rtrortgagee or mntraU seller � _�
Ailtlress W mortgagee w mntraa se0er (numher aM svee4 �Y. state. ard Z/P cade) - ' I '
�o...�:01,......••
Name of assignee or oNer owner or halder ot rrortga9e 1,
Mdress of assignce (num0er and sbee4 tlN, siafe. aM ZIP cotle) °`�,�� et 33�. �. ..
Caid�p:...•• '�(�5.6D
Does epplicant ovm property in any oNer If yes, what munty? NTa1 Tap�g Distrirl? � � �,,
counry in InEana? ❑ Ye5 � I
❑ No LJ No
20 _ 20 _ 20 20 20 20 _ 20
�nature W Coun�Y Auditw Counry Date (monN. daY, Yaa�
I I We cert'rfy under Ihe penalry of perjury that the above and (oregoing infortnalion is We and cortect and Ihat the applipnt is a resident of IrWiana antl
ovmer I contrad buyer of ihe aforemerrtioned property on date applicatio� is filed.
7rature (owneh fu0 reme) Date (monDi. day, Yeah
...-.�a �[ /
� /� w�0 / 'IY `�G w, � �.S
II resident atltlress ot ppfrant (number and sbeet ��}: state, an0 LP ootle) /
� — ' r � n�c, � %!��/
auNOirzeO by Cuty executetl Power W Ntomey or by IC 61.1-12 .7 Oale (monN, day, yaa�
dress of auNuved person (number arM snre4 �y. s+ate. antl ZIP code)