HomeMy WebLinkAboutMortgage_Schmittler � as STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
e_... s FOR DEDUCTION FROM ASSESSED' VALUATION
State Form 43709(R73/10.15)
• • Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. J IIAI' Fa7JlU
fidwith:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. V I■V J L U I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. • .. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c:1�.•
where the property is boated during the twelve(12)months before March 31 of each year the deduty�pr� F:rlf
See reverse side for additional instructions and qualifications. tilDJU ,1 UNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
MATTHEW R. SCHMITTLER
Taxing District Key number/legal description Recydpyrp r Paywpu fiber
FORT BRANCH 26-19-19-103-000.231-026 t/J�/\UI Q)� 51
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$ 108,565.00 0 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
17 Real Properly ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgage or contract seller
ACCEPTANCE CAPITAL MORTGAGE CORPORATION
Address of mortgagee or contract seller(number and street.city,state,end ZIP code)
101 PLAZA EAST BLVD., SUITE 103, EVANSVILLE, INDIANA 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in a y If yes,what county? What Taxing District? Has this deduction been request It yes,sate amount of deduction
other county ,�/y on property for
in Indiana? ❑Yes L'J No current year? ❑Yes ZNo
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded 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 the deduction.
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 afar-mentioned property on date application is filed.
Si•nature(. met' fug name Date(month,day, ear)
05/ �(e, /2016
Full resident address of applicant(number and street,city,state,and ZIP code)
907 S. LINCOLN STREET, FORT BRANCH, INDIANA 47648
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 fine not to exceed$10,000.