HomeMy WebLinkAboutMortgage_Schmidt (4) :} . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
f f' FOR DEDUCTION FROM ASSESSED VALUATION g
�L-- - Slate Form 43769 rtm/6-u9) p
Presaiberl by Department of Local Government Finance 1M
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county whew pkcert2 In4cated. Form fled with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. S County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re durin8 the twelve(12)months
before March 31 of each year the deduction is sought ,/// • � ❑ County Recorder
See reverse side for add.t nal instructions and qualifications. GIBSON COUNTY
Applicant(owrcror•• •.r-see -••i.:. rey ars,e sida)\�14`// C // l AUDITOR
l W∎. Lko Tf010._ 1 • numcregal d7 03— —oo1
737 0_27 391 Pagto
Assessed value of real property as of Mortgage I tract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app�t the sole
Math 1,current year Marti 1 h� date of appacatnn legal or egwtable gmeR
0000 ❑ Yes ❑ No
If rn,what is his I her exact share of interest? / If owned with someone other than spouse,indicate with whom
If name on record different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
•
Name of mortgagee or contract setter
Address of mortgagee or contract setter(number and street coy.state.and code)
Name of assignee or other owner or holder of mortgre
Address of assignee(number and save, .-- Gcode)
county applicant own properly in n A.••_ • hat county? • What Taxing District? for this deduction yea been requested on property
Indiana? CC. ❑ Yes ❑ No
..�0• y�
•••C I COUNTYAUDrTOR
Orauctin-" et:
-
e / 9`��`•'� a`O.�V (ctrl` I'T 20 20 20 20 20
giy G J County Date(month,day,year)
I I W. __ .:penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner. U. •..ryer of the aforementioned property on date application is filed.
%retu or. Date(month,day.year)
- /.: �•
Full resident e of applicant(riafibet and street.city,state,and ZIP code)
'D, 1/7 nl 3 so 6 T MIearTOAI . -r-k/ tl 2 G 70
Person 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.end ZIP code) .