HomeMy WebLinkAboutMortgage_Schlumpf`° rt"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
S �� � State Fortn 43709 (R4/ 70-0i) �
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� PrescnDeO Oy Depariment o/ Loral Govemment Finance
INSTRUCTIONS:
Coun Township Year
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� File 69,3rk,
LUUJ
To be filed in person or by mail with the County Auditor of the county where the property is located. MA 1 1
Filing Dates: 1) Real Property: During the 12 months belo2 May 11 0) the yea� the deduction is to be�effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0( theJ�y�e�a�r t�he�..,d�eductron is to 6e eflective.
See reverse side /or additional instructions and qualifica6ons. ��,�/""'eJ��� "�h�� 1���
Applicant (owner orcont 6uyer- see restricti n on reverse side)
Taxing Dislrid y number / legal description Re rd mber
��D/{� S�DD�f V., Q� Page number
V �VI (/ VN
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant t e sole legal or equitabie
March 1, current year March 1, currenl year owner? ❑ Yes ❑ No
SD
If no, what is his / her exacl share of inlerest? Ii owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of appticant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 6-1.1-�
�me of mortgagee or contrad seller �
3
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code) .
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaRQ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo 0_3 za 6 zo zo Q(�_ zo �� 7 zo �� zo �
( � �
Signature County Auditor Date
'/ We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat lhe applicants was / were
� residen Indiana and owner of the aforementioned property on March 1, 20
Si n re �w s(ull na Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu re - ent address of pli n Address of authorized person
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