HomeMy WebLinkAboutMortgage_Schapker (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ni Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
:, State Form 63709(R13/10-15)
-s---..-. .. Prescribed by Department of Local Government Finance
INSTRUCTIONS: Eby � P�G9 20 1leMark
Filing Dates.- 1) Real Property.Must be completed Form with:
pitted the dated in Auditor or County Recorder of the deduction is sought.rriq D`j O7f County Auditor .
Must be filed a posbrrarked with the Courity Auddor or ,y _
located on or before January 5 of the immediately succeeding calendar year. ,jY Nu ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the CountyA •P 1 • - county
where the properly is located during the twelve(12)months before March 31 of each c>'r - •eduction is sought
See reverse side for additional instructions and qualifications.
Apogean(owner or contras tzser-see restrictions reverse ) •
Taxing District Key number!le al Rend number Page number
s fie-/7-0-9-too °"/. 5J6-o0- / c of a9oa-
Psessed value of real property as of (IMortgage/Contact indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,Gerard year l assesanmd data,ascent year date of appgcation legal or equfable owner?
/p / 0/ 9 CI yes 0 N
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
As Real Property ❑ Annually Assessed
/ Mobile Home(IC 6-1.1-7)
Nacre of mortgagee or seller p' ` /1.h
l Ql IL/nit /nom, ,'o/ '�q•u"��'�7�/�
Address of mortgagee or contact seller(nun street,city,state,and ZIP edyV ) '
Name of assignee or other owner or holder of mortgage '
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Address of assignee(mottles street,cry,sate,and ZIP code) .
en
Does applicant own property in any If yes,what county? - What Taxing Distdg7 Has the dedud'ion been requested If yes,state amount of deduction
other
hdia�? ❑Yes ❑No acemeennt year? ❑Yes ❑No
A person is not exalted to this deduction unless the person has a balance on the person's mortgage or coutract indebtedness that is recorded in the county '
recorder's office(including any home sway fine of credit that is metaled 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
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Signature of County Audiit r County Data(mite,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.
sgcetoe(v N6 ) o , Date(month,day,year)
Fudi resident applicant(number and-,y'•; state,and ZIP code) J
pe 6 /Sps c. T-�E !'X- _ - e,.<l� cedes y v r7/e�_2--AV ,r-
�isbh autmdzed by duly executed Pourer of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,state,and ZIP code)
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The penalties for pegury can include imprisonment up to two and a half years and a fine not to exceed 510,000.
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