HomeMy WebLinkAboutMortgage_Schleter °�'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;10.2-f,•1A. FOR DEDUCTION FROM ASSESSED VALUATION
‘;-;i"• -II State Form 43709(R12/6-14)
•' ; [ Prescribed by Department of Local Government Finance V"\-16.)INSTRUCTIONS: File Mark
To be filed in person or by mail. A. 2.Q�S Form fled with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the d�((on iss sought.
Must be filed or postmarked with the County Auditor or County Recorder of the cur hfrwhere the p 4,• y is 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ..j r n$ ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Co . Au•-:�D. _ . ) Y
where the properly is located during the twelve(12)months before March 31 of each .Z,,i,1 ;s1-,. 24. is sought
See reverse side for additional instructions and•qualifications. �QN GOU
Applicant(owner or contract buyer-see restrictions on reverse side) GO°
SFele,n L.. Cr S4 no;ce r L. Sch I c-Ft r
T ' Distjct Key number/legal description Record number Page number
Q 21L 96- Ia-3b- loo-000.L.ao -bou aois L/(01
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mardi 1,.Wrrent year date oofpplication 1. legal or equitable Yes ❑er?
If no,what is his/her exact share of interest? 1W! 9 owned with someone eoeonnee other 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 ❑ Annually Accessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
I-yrinv i II e,• Na+i ont •
Address of mortgagee or contract seller(number V^` _ 1e1/1 c I \VO L
Name of assignee or other owner or holder of rtu 'lJy`,1 �+j\ �� \, Vcici
Address of assignee(number and street.city,str
i 2
Does applicant own property in any H yes,whi ��r �J 0 teen requested If yes,state amount of deduction
other county 1
in Indiana? ❑Yes ❑No t 1 i Yes ❑No
A person is not entitled to this deduction un. tract indebtedness that is recorded in the county
recorder's office(including any home equity N.-3 -AD 1 at is the basis for the deduction.
(t 1{
Deduction approved in the amount of: `^' — �
20 20 aO1 1\,`/�` \ t(;/ 20 20
Signature of County Auditor L`-'`\` \JW Date(month,day,year)
J
N �
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.
cure(owner's r nem- Date(month,day,year)
F Ile Merit addl.- of applicant number and street,city, e,and ZIP code
l.1 L 5O S I il'1<e4D TJ fit/ 1/7(07Q
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,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a tine not to exceed$10,000.