HomeMy WebLinkAboutMortgage_Schmits (5) SSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R1116-09)..-
Prescribed by Department of Local Government Finance 7
File Mark
INSTRUCTIONS: .
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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. • County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months �;.acorder
before March 31 of each year the deduction is sought. I 41,:n I,
See reverse side for additional instructions and qualifications. GIBS e - : , . OR
Applicant(owner or contract buyer-see restictiOITS on reverse side)
tS2n4- A . SChn'tA'S ccrrl Co,—; L. Sc1-m;I'S
T - District Key number/legal description Record number Page nu
g6 - id - a3 - 300 . 000 , 030 - 0° Y- o'D/.3 /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,amend year Mardi 1,current year date of application legal or equitable owner?
I cid, So() //16,sbo ® Yes ❑ No
If no,what Is his/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: Is the property in question:Annually Assessed
. VI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet,city,sate,and ZIP code)
10 no h. .3(z0 'll t inn(n S41 i iTsper '(-?6•11-O 1tO
Name of assignee or other owner or holder of mortgage / ^ l'
Address of assignee Si-mer and sheet city,state,and ZIP co /rt.'- Z'l/�/ jen/n
T Tit a - 2. — /0 ( CJ" wK1_ CA r r"
Does applicant own property in any other r�r If yes,' �t ) /��y/r/t Auction been requested on property
county in Indiana? ❑ Yes [RR No V'D f J—,&o /✓ ❑ Yes ❑ No
Deduction approved in the amount of.
20 20 20 1 ) 20
Signature of County Auditor County Date(month,day,year)
I/We certify under 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 I con.- buyer of th' aforementioned property on date application is filed.
Signature / na .-) Date(month,day,year)
%� i V ,3/�c,/203
Rd. .:.. of-•• t(n col:sate,and Z/P code 3 5 r_ 0 el So S � .-,� �� ek
P J authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) '
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