HomeMy WebLinkAboutMortgage_Schlottman (4) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
��,;: FOR DEDUCTION FROM ASSESSED VALUATION
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State Fors 43709(R11/6-09) f i rt�
Preset-bed by Department of Local Government Finance ! i i_
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INSTRUCTIONS: - .
Fonn Ned 7b be filed hi person or by mail with the CountyAuditw or County Recorder of the county where the property is located.
2 9 ZU 14
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months unty R rd
before March 31 of each year the deduction is sought - ❑
See reverse side for additional ins �ryy5 and qualifications. GIBBON l:f11INTy AUDf I,
Appficart owner or centred atryer-//K/J �' sm1verse,siQe) OR
Keyryrtnba-C//i6/').`/�/LJ/qn /�a�}rte/},( y7
Taxi ij//_ 7 O / 'r o•J-o ///,,��//,,��////z2-OAa Iv- 3q Page number
Assessed value of real property as of (,/,(!/ 1 Mortgage/Contract Indebtedness unpaid as of 'MMortgage I Contract indebtedness unpaid as of Is the apprmant the sole
March 1:area year I March 1.=rent year I date of appGcabon . 9 legal or equitable owner?
It no,what Is his/her exact share of interest? If owned with someone other indicate with whom
CI Yes El No
If name on record is dt`erent than that of applicant indicate belovx Is the property in question:Annually Assessed
eat Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller We
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage Q /3
Address of assignee(number and street city,slate,and ZIP code) (lei/4244a° (�[)J(�^J
- 1 tot....Taeng District? Has this deduction been requested on property
county in Indiana? .— fw current ye ?-_. ___.:�_:.�> _ _ «...: _-_ .._. ❑ Yes ❑ No
TOR
Deduction approved roil Drawer NO
20
Card NO. 20 20 20 _
Signature of Calmly Aud qty Date(month,day,year)
I/We certify under the penalty of perjury that the above aria foregoing intonation 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. .
•nature(owner's fW .` I Date(month,day,year)
LL
N I.. ►A.r a Al... !a -)9- 20/V
uS resident...,. --of apparent(number and sheet 4l:state,and ZIP code)
SOS die v✓yu1 Tree L(f,g PPTY,cef-v-� D3 LI7670
Person authorized by duty extewted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city state,and ZIP code) .