HomeMy WebLinkAboutMortgage_Schmits (4) rile. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
uR- FOR DEDUCTION FROM ASSESSED VALUATION ITy I L Pr 1)
''• ' State Form 43709(R11/6-09)..,
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: _,r,., :1►).Fi,: I
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. M County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought 1� vdr1)yi,•eoorder
See reverse side for additional instructions and qualifications. GIBS C - : . - OR
Appacam(gwneror contract buyer-see restrictions on reverse side)
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T District Key number/legal description Record number Page nu
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1.current year Martin 1,/current owner?
ent year date of application legal or equitable owne
14Cj, SUo NZ',-5-00 ® Yes ❑ No
If no,what Is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Annually the property in question:Anally Assessed
. 'Xi Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter
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Address of mortgagee or contract setter(number and sheet,city,state,and ZIP code)
To Oct x :3(p0 -7 ii (Ylpin S4, r?iiSP.p r =z-t-3 'h. SY)-v-N> O
Name of assignee or other owner or holder of mortgage l
Address of assignee(number and street,cry.slate,and ZIP cod /i ...Sag/72/ /
Does applicant count in Indiana? property h any other If yes.) —46-4/3-
��� yew ❑ yes property❑ No
❑ yes PS No I ,D/�
Deduction approved in the amount of.
20 20 20_I 1_ 20
Signature of County Auditor County Date(month,day,year)
I/We certify undei the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/con.: buyer of th- aforementioned property on date application is filed.
Signature • .•S: na .:) Date(month,day,year)
Full —.•., .-_ of... t(n and sheet,a7y,state,and ZIP node n 37 '7�'/3
3 5 _ o Aso s A 111
P S • authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .