HomeMy WebLinkAboutMortgage_Schmidt (2) •.,A". STATEMENT OF MORTGAGE OR CONTRACT INDE T SS t. S Township . Year
r.--,.:;% FOR DEDUCTION FROM ASSESSED VALUATION �` �„/ n
-t '�� State Form 43709(R11/609) -0$[�Y / y/�c�0 20)5
S\, - Prescribed by Department of Local Government Finance 5 r r l L
INSTRUCTIONS: JAN 5 11116 File Mark
To be filed in person or by malt Form Ned with:
Filing Dates: I) Real Property:Must be completed and dated in the calendar year for which t - u :. i ht.
Must be filed with the County Auditor or County Recorder of the county where T:'��'•.�101mf.'Ste 12 County Auditor
on or before January 5 of the immediately succeeding calendar year.GI BSON CO N Y AUDITOR County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
cant(owner or contra buyer-see rest itlbns on reverse side)
9'CG/a t, Xi �J IX J1l- d-.Slheray L. Shiei.tcccf
Taring District Key number/legal description Record number Page number
a(e- 17-1(e-/QV _cal s�f8- al ').otL- ")_
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,aurent year March 1,current year date of application legal or equitable owner?
4'45-1P)60o. O 4/o3, 9L/te.9/ 450,0(Y).if° O Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that or applicant,indicate below: Is the property in question:Annual?),Assessed
O Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
of mortgagee or contracts seller
rs-(- Nat, aid- CO-t k i -
Address of mortgagee or contract seller(numbyer�and street,city,state,and ZIP code)
ao l 6 MGU,Ik-s+ -CcOL/tiLl . u 1R2ical _. . • _
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) --,-_-_ — _ ----- - - -
• .-t:6 De-- I
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on pnmperty --
county in Indiana? _ for current year? ❑ No
__ ___S_Yes --GI No - - ____ __ _ . - . ❑ Yes
__. _. ____ _ _ - .--_— ._ 1_ _ ._ -
- --'- --' - - - 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.
S(gn.. -(.. e . lull na!e)/ , I - - 'Date(month,day year)
7'. ra y:� 's4 .a ss .•.. ` J k - s21..l Ta - /0a - -
Full resident address of applicant(number and sires!y,state.and Zlew - -
&')S3 S/000 1,1 °We 's-vt'llt / 766S-
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,dry,state,and ZIP code)