HomeMy WebLinkAboutMortgage_Schenk (2) t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coup i E Year
FOR DEDUCTION FROM ASSESSED VALUATION
n` . j! State Form 43709(R11/6-09)
Presented by Department of Local Govemnent Finance
File Mark
INSTRUCTIONS: _ 't1 ,!I-or 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. , ,,
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months • .i
before March 31 of each year the deduction is sought , , , Ts vs%!RT. .
See reverse a for additional instructions a(ndgq lifcations.
GIBSO - - • ` • • "
Applicant( r or contract buyer- restrictions
side)
a
Taring District q b� e _q qn d P6;6_1/4-7-/770 J - a)J . 1 9/ oc?? / /! 3 J 20"
Assessed vat of real property as of
Mortgage/Contrat indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Marts 1.arena year Marsh 1,ainent year data of application legal or equitable owner?
❑ Yes ❑ No
If no,what is Ns I her exact share of interest? lt owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
/�'�Property ❑ y Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or antral seller ( l ��.
Address of mortgagee or contract seller(number and street rdy, te,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)" (� ! t— - /0
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yell ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of. _ `y' I, I,'t,d
20 20 20 Ws' 1 L ot.) sc l-� `r`'' 20
Signature of County Auditor • t nfh,day,year)
I/We certify under the penalty of per)ury that the above and foreg {Sr 31 ;a resident of Indiana and
owner/contract buyer of the aforementioned property on date ap(
1 Signature()o,•' rr� _ nd,,day.year)
F '—"'cent address t rum rand scree I 2//G2ai3
p ( t city,state,and ZIP code)
--••
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of audio,iced person (number and street city,state,and ZIP code)