HomeMy WebLinkAboutMortgage_Schultheis (2)��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�«. / j State Fwm 43709 (R6 / SO61
� Prescnbed by Department of Lorel Gwemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of fhe county where the p�opeRy is locafed. AP R 1 2 Z��%
Filing Dates: 1J Real Property: During the 12 months before June 17 0/ the year the deduction is to 6e eflec6ve.
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 of the �ah�de�6�on is to be effecfive.
See reverse side fo� additional instnictions and qual'Arcations. GIBSON COUNTY AUDI70R
see iestrictions on reve�se
Assessed value of real property as of
March 1, curtent year
no, what is his / her exact share of interest?
/
-ii 3oo•�v.og�-o �- s
March 1, current year
7a,�n°
If name on record is difterent than that of applicant, indicate below:
�e of moRgagee or contract seller � �
Address ot moRgagee or contract selier (number and s
Name of assignee or ofher owner or holder of mortgag
�
Address of assignee (number and stieet, city, state, Z
�_
Does applicant own property in any other If yes, wha�_
county in Indiana?
20 (71
P
Signature
2� Q� 2� � �
7 1
Recortl numbe� �� v 7
Page number � 3 y 9
as of Is the applicant the sole legal or
owner? � Yes � No
If owned with someone other than spouse, indicate with whom.
, -
s the property in questlon:
❑ Real Property � Moble Home QC 61.1-7)
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iestea on
YesO No
1;, We ceRify under the penalty of perjury that thc ints was / were
s�dent oi Indiana and owner of the aforementioned propeny �„ ,..... __
»gnatur (owner's fuU a ) Person aufhorized by duly executed Power �� .,.wmey
k��. �-i/�� .�,�_ -, a� bY �� 6-,.,-,2-.0�
Atltlress of authonzed person
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