HomeMy WebLinkAboutMortgage_Schafer .smi STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-- <=,• FOR DEDUCTION FROM ASSESSED VALUATION
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'' !?'' �1 State Flynn 43709(R12/614) •
•'.;elf, Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAY 1 9 9,p.f
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the property is '{,6County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder the 2) where the property is locate. curing the twelve(12)months beforeuMarch 31 of each year the deduction u . ••••• :•+ Vr'T"A
See reverse side for additional instruction 4. qualification I 5oN COUNTY gUA170R
Applicant • -r or contract•uyer-see res .-ons on reverse ,ll�
T-. • a -,dct - i Key number/legal description Record number Page number
/ 03/0-- do-a6 - 'a'o- coo. /2/- co/ t,z o i / l9 / C'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebt ness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application / .C- or legal or equitable owner?
• (t-1" x '❑ 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 of applicant,indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
•
•
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
.61-4) Ott iYii;)a-,040
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount f deduction G
other county on property for JO( A
in Indiana? ❑Yes ❑No —, current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the pi ` ---ne or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the co ""'•.t is the basis for the deduction.'
Deductions oved in the amount of: COUNTY/ D 1', ,el NO \c2cp PPr SS99
20 20 20 20 r Cola A1O `� •.., 20
Signature of County Auditor County 'k r.,7 in
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the apply..._. :nt of Indiana and
owner/esntract buyer of the afar:mentioned property on date application is filed.
Signatur?• •- full e Date(month,day,year)
F •sid r t address of.ppli . t(number an.street,city,state,and ZIP code) ��/�<�
-erson authorized by duly executed Power of Attorney or by IC 61.1-12-07 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$10,000.