HomeMy WebLinkAboutMortgage_Schroeder > STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
ateA'° ` FOR DEDUCTION FROM ASSESSED VALUATION LE
- State Form 43709(R13/10-15)
"-- Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 1 9 File Mark
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
Must be filed or postmarked with the County Auditor or County Recorder of the county where the •y•-fly is r • •unty Auditor
located on or before January 5 of the immediately succeeding calendar year 1. •. 7'"11r
❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CouMyl}y Elm, . ? - -•!Wit AU ni-N 1 R
where the property is located during the twelve(12)months before March 31 of each year life•••at . .
See reverse side for additional instructions and qualifications.
•.... - or tact buyer-see restrictions on verse side)
Taring Cr-, /+� number I legal description Record number Page number
0 , - ' I' a./ '74/ -ICI- 0147 - 000- ?5V-o0 7 c01 -7 393Jc
Assessed value of real property Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of apps legal or equitable owner?36, 103 ❑ yes 0 N
If no,what is his I her exact share of aimaan If craned nth 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 ❑ AnnuallyAssessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contras salter
\
Address of mortgagee or contract seller(number and beet rny,state.and ZIP code) ._•
-
Name of assignee or other owner or holder of age
)et-ikr
Address of assignee(nu -/r and street city,state,and ZIP code)," " O.�O
O'�tcn / vit !O7//if rZ /:vim Cdr r
Does applicant own property in any If yes,what county? What Taxing District? ��0 �1 ( '•.• eduction
other county /y
in lndiana7 ❑Yes 0 N
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o. _ in the county
recorder's office(induding any home equity tine of credit that is recorded in the county recorder's office)that,,. •
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 1 contrail buyer of the aforementioned property on date application is filed.
re.(owne s full name). Date(month,day,year)
1 'as A ':u.I �tl)2/ .♦kW
presid(�ent address of '.=.I.—, nn�n�/' and sheet city,state,and ZIP code) CA, �--�"� / �7 / �t/,h /�
P Oil authorized c ' " v' t of7-t orOak/ann -t Al -Y l Lo&O (month,daY.year)
Address of authorized person (number and street Tity 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. -p— -Tr r�� --