HomeMy WebLinkAboutMortgage_Schmitt (5)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7 hi Year
:, �-
= FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fortn 43709 (R11 / 609)
�' ,,,, Presuibetl by DepartrneM of Local Govemmenl Ffance
DEC 5F��e@�IN
��NSrRUCnoNS:
b be filed in ��
person w by mail with the CounryAUditw or Counry RecoNer o/ Ne counry where the D�PertY is located. C.�
Filing Dates: 7J Real Property: Must file durirg the year lo� which Ihe deduction is wught. nty Auditor
2) Mo6de / Manulactured Homes rat assessed as Real Properly Musf (7e dunng the fwelve �72� months n
6ePoreMarch3fo(eachyearthedeductionissoughL GIBSONC UN4YA6Qi4��°bef
See reverse side lor additional insWCtions and qualdications.
Appfi�ant (ojmeroroontraC 6uyer- see msfiraons m reeerse side) � .
o�smm
share of intefest?
It name on remrd "a dRernnt Ihan that of aPP�4 �inte bebw.
w�e
- a7 - cb . a 7� oa.7 ac,�3 X� �
de6letlr�s unPaid az W Mwt9a9e / ContraC uWebteAnrss unV� as of Is ihe aPP�^t Me sde
/� date of aVP��� I�al or ewBade ox�Y?
� V ❑ Yes ❑ No
shee4 cify. stste. aM Z/P cnde)
�9a9e
(number aM street �1: slate, an0 ZIP catle)
Ooes apd�m!n own P�DenY in any oUer
munry in IMana?
❑ Yes
Deducfian appioveC in ihe amount ot
20 _ 20 _
signan,re d CamN nuanor
u yes. wnai
�
If owned wieh someorie other Ihan spouse, iridinte with wtrom
Is Me property in questirn: M�waAy Pssessed
� Reai a�oaem � nmuanr aue�a
wo�� r� nc e
"_
T a�o.3......
— Dra�ver \0......... st��P�
$593 �� ❑ �
C�YCi \� . .....................
COUNT •
20 � [u
Caunry
20 � 20
I/ We certify uMer ihe penalry of perjury that Ne above and foregoing infortnation is W e and cortect arW ihat Me applipnt is a resident of IMiana and
owner I contracl buyer of Ne aforementioned property on date applica0on is filed.
�na1?re {ov rs hA name)n S // Date (monfi, daY. Y��
�/ / �Y L
FWI
dWj executetl
tiry, state.
,6st
/ddmsso�aWwr¢eApersrn (numberaMSbee(dry.sfate.andZlPcntle)
�
Date (rtanN, tlay, yea�