HomeMy WebLinkAboutMortgage_Schumacher a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'Sill FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R1I/6-09)
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Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
b be tiled in person or by mad with the County Auditor or County Recorder of the county where the property is located. Form road with:
Filing Oates: 1) Real Property:Must file during the year for which the deduction is sought Eli:El)
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. n r t
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•D A•• Key numbal legal description Record number`/'�/Pa e
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpara'a5W 6PRrani di' e A so�
Mardi 1:arrant year March 1,current year 'glcbon legal or equitable owner?
❑ Yes ❑ No
If no,what's his I her exact share of interest? If awned with someone tier than spouse,indicate with whom
If name on record is different than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Nmualy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `tin ., ,1'-�a
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) U
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code) W Man,8 LL-. 0 — --
Does applicant own property in any other If yes,what¢ Drawer NO�tel�•�O�'f t) dmn been requested on property
county in Indiana? Or `�
❑ Yes ❑ No 1 ❑ Yes ❑ No
Deduction approved hi the amount of: • �a).C` NO. ����
20 20 20 20 20 20 20
"Signature of County Auditor 4 County Date(month,day,year)
I 1 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 pro rty on date application is filed.
r(owner's V / Date F,WJ(\'7Men number a s7reeL thy, .erxd ZIP m r� .
Person authorized by duly executed Power of Atomey or by IC 6-1.1-12-0.7 \\�,Y_\ Date(month,day,year)
'ess 1jaj1umberand street city,state,and ZIP code)