HomeMy WebLinkAboutMortgage_Schuble mss'°a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-cfm;',1. FOR DEDUCTION FROM ASSESSED VALUATION
j =02,' State Form 43709(R12/6-14)
''' ;; Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail AUG 5 2015 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the .perty is , County Auditor
located on or before January 5 of the immediately succeeding calendar year • I. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County, ' o• '
where the property is located during the twelve(12)months before March 31 of each year We c.. ta.M U C rTJH
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
'rig ' iris I Key numbe l x
legal description Record number Page number
k�C — $-3(0- 3-no-b0 . 03O-oast a o ( 5- I lo (
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
1,anent year March 1, rrent year date of application legal or equitable owner?
• II 11ct Q Mfl—C) I Yes ❑ No
If no,what is his/her exact share of interest? J If owned with someone other than spouse,indicate with whom t 1
If name on record is different than that of applicant,indicate below I•s Jyt:property in question:Annually Assessed
eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name S mnrtn=rim nr-- tract seller
ni
.•� ■ — t lo
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Address of mortgagee o‘•ntract seller(number and street,city,state,and ZIP code) __
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Name of assignee or other owner or holder of mortgage .14---- _____
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Address of assignee(number and street,city,state,and ZIP code) .1 1t Q S�d� ` �`�4��C �p
Does applicant own property in any If yes,what county? What Taxing District? 'au ( s 1- . I C. :of deduction
other county ' ( I J
in Indiana? ❑Yes ❑No I current yo....
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract iota._. "ed in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for uro _ .
COUNTY AUDITOR .
Deduction approved in the amount of: •
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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.
Signatur ( tub n - / // Date(month,day,year)
Frresident address of ap licant• ber and streaity stat an ZIP co e)/0.211 a. Izeati
erson authorized by duly executed Power of Attorney;Ay 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 fine not to exceed 510,000.