HomeMy WebLinkAboutMortgage_Schmidt a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
;�, FOR DEDUCTION FROM ASSESSED VALUATION I
State Form 43709(R71/6a09)
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Prescribed by Department of Loral Government Finance
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INSTRUCTIONS: gp�TU,A., ,
M be filed in person or by mail with the County Auditor or County Recorder of the county where the pm petty is located. U t.I -r O'2013
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. El County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months)
before March 31 of each year the deduction is sought ecorder•See reverse side for additional instructions and quafit-cations. GIBSON COUNTY AUDI
Applicant(owner or buyer-'see restriationson Amrse
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Taxing District g number legal 7 Ioo—Co�- /31-aft ,7 Record rwn Paif 8186a
Assessed value of real property as of Mortgage/J Contract indebtedness unpaid as of of Is the appgcen� t the sole
March 1,current year March 1,corr. date of application legal or equitable owner?
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I ODD ❑ Yes 0 N
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant.indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
T- I — Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller CO R , ' Drawer N0,,QQ
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Address of mortgagee or contract seller(number and street,city,state,an V& r1
2t.
Card NO.
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has Nis deduction been requested on property
county in Ind¢na? ❑ Yes ❑ No for anent year?
I ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County I Date(month,day,year)
I t 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 contract buyer of the aforementioned property on date application is filed.
reture�('a`w/*�n�/g',i's`�'�N'e'n ante .. Date(norm.day year)
Pe‘ address number end sheet,rrry.state,and ZIP code) I /a/30As I
Pe+iwhaut orvsd by duy executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of any person (number and stme4 city,stale,and ZIP code) .
7/7 Ai SSD C . AeIn7 a 771 X7670