HomeMy WebLinkAboutMortgage_Scheller (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fwm 43709 (R71 / 6-09)
�` � i p��i'6ed by �epartment af Local Govemment Fnance
f�C
wsrRUCnoNS:
To be fi7ed in erson or b mail with the Cow Auditor or Coun Recorder of the coun where the ro F m
P Y �Y �Y �Y P PertY is located.
Fdirg Dates: 1) Real Property Must fJe dunng the year (or which fhe deduction is soughG Counry Au �mr
2) Mobde /Manufactuied Homes rrot assessed as Real Pioperty: Must file dunng [Ae twelve (12J months �
be£o�e Ma/ch 37 of eaclt year fhe deductnon is wught N� SCouqTRecorder
LuIL
See reverse side tor addrG'onal instructions arM qualifications.
Mv�� (oyraK wm�traU bygt' � re�ls 4^ re' _ ' _ . � / /� /I . .
i sm¢ / 1 (,,,� /—���a�l `_ � D K� Ov�•'2�3 6 REtb'RIhUTtlW••�• Nay�wLnoenK
� �r a
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Aaessed raqm of � pfopaty av d Mortgage / Confrarl intlehted�xss unpaid as of Mortgage / ContraU'vdebte0nes5 unpaid as d Ls the aPP��I tlie sole
Mad� 7, tarrent year MafU 7, yeer datc of aDPOm�� 1eg21 or eQUitahle wmeYl
❑ Yes ❑ No
tl ro, what ts his / her e�r1 share of infelest? H owneE wi� someone atMl tt�an spouse. mdxate wilh whom
Ii name on 2mrtl a dMerent Nan that of aGP�l iM'wate bebw. Is Me P�7ert1' in 9uesfion: MnuaM Assessed
❑ Real Property ❑ Nmually Assessed
MobOe Fbme IC 61.1-7
Name o( rtnrtgagee w contraG se0er �^�
�
Add`ess of irorl9agee w mntraG uAer (numbrl erd sfreet uty, stafa. aM ZIP code)
AqCmss oi asvgnce (nurtNerantl stree; �
Dces aPPlinnt own pmperty in any oNer
munry in Indiana? � Y�
Detlucbm approved in the arteunt o'
20 _ 20 _
Sigrenne ot CamN Auditor
mortgage
�� � �aa
under the penal„ ,,. ,....,...� ..�. _._ ---. - -..-
act buyer of the aforementioned prpperty on date appiiradon is filed.
iW t u an0 sLee4 �15 stak
by duty exeated Povrer af Actomey or by IC
Adtlress W eumorvea pesson (numDer arro sbee; tlty, smte,
7
�0 _
20 _
trdt^ (monfh. QaY.YEa�
� P�P�Y
❑ No
2� _
id correa arM that the applirant is a resident of Indiana aM
Date (rnonlh, da