HomeMy WebLinkAboutMortgage_Schutte a tom,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS co. '?gt} ;�;��}!�
f�;2'„ all ar
FOR DEDUCTION FROM ASSESSED VALUATION
a_ t" State Form 43703(R71/609) � �
Presorted by Department of Local Government Finance m
INSTRUCTIONS:
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form filed
Filing Dates: 1) Real Properly.Must file during the year for which the deduction is sought. uditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)nwnth§ r.pC1
before March 31 of each year the deduction is sought. GIBSOd') C[�])N�', er
See reverse side for additional instructions and qualifications.
Ap t(o Meyer Tax"ug • Key number desci ..pJ Record number umbe
1, Q6,- 'Si4°M3-obi/?9-Oc 40/3 a �
Assessed value d real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,and year March 1,cement year data of application T legal or equitable owner?
/Qey� O ❑ 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: property in question:Annually Assessed
1ReReal Property ❑Annually Assessed
MobBe Home(IC 6-1.1-7)
Name of mortgagee or contract seller )7 /r
i f/�/Z
Address of mortgagee or contract seller(number and sheet,city,sate,and ZIP code)
Name of assignee or other owner or holder of mortgage --
Address of assignee(number and street thy state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yea!?
❑ Yes rl No
COUNTY AUDITOR 5 J,� n-E-, R
Deduction approved in the amount of: v`,
20 20 20 20 20 ► 3 8 a
Signature of County Auditor County
I/We certify under the penalty of perjury that the above and foregoing information is true and corma miu amt me applicant is a resment or malaria and
owner/contract buyer of the aforementioned property on data application is filed.
Signature a full name) nit / Date(month,day.year)
a . .L}t/ hsY2✓w�t
Rd resident ad of ap�^t( umber and sheet city,state,and ZIP code)
1\ lira? AAda._ c pC 4 Rrc..s. 7•(J if-76 cee
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) w``
Address of authorized person (number and sorest city.seta.and ZIP code) 1 ..