HomeMy WebLinkAboutMortgage_Schmitt (8) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ant FOR DEDUCTION FROM ASSESSED VALUATION 1
LiState Form A370g(R11/649) FILE 1.
Prescribed by Deparmrenl or Loral Government Firence
File Mark
INSTRUCTIONS: I�/q�n�I� ((�� ��� I Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where tht4 Apart)dfs
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I ki. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during th twelve(1 mo
before March 31 of each year the deduction is sought
❑ County Recorder
See reverse side for additional instructions and qualifications. G I E S ON COUNTY AUDITOR
Appfcant(owner or , j , �` 1 I
4 _ :t Jh-rnif I
Taxing ,Key number 1 1 description RemN Page n
(/KC �v /9 020 X00-00ade3-0d5 ; i io
Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appfrant the sole
March 1,area year March 1,current year 571/S7O_ap date of apptcatvh I legal o❑equitable es owrreN
(J/ ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,ldca i te with whom
If name on record is different than that of applicant,indicate below-. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• I Mobile Home(1C 6-1.1-7)
Name of mortgagee or contract seller
tiY1/042 an Vila, I
Address of mortgagee or contract seller(number and city state,and ZIP code)
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? Iias this deduction been requested on property
county in Indiana? cur
❑ Yes ❑ No for rent yew ❑ Yes
❑ No
I
COUNTY AUDITOR
Deduction approved in the amount at
I
20 20 20 20 20_ 20 20
Signature of County Auditor County I Date(month,day,year)
I 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/contract buyer of the aforementioned property on date application is filed.
SI core`OJt*,1�e„raa.) — I Date(month,day,year)
Full resider applicant r and or, ,,/ a and LP code ,'j l ' ) 1 76 va
Person authorized by duly executed Power bf Attorney or by IC 6-7.1-12-0.7 / I Date(month,day,year)
Address of authorized person (number and scree;city state,and ZIP code)