HomeMy WebLinkAboutMortgage_Schmidt .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 t 10-15)
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�--- Prescribed by Department of Local Government Finance r
INSTRUCTIONS: •
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lb be filed in person or by mail �F�oo filed wlt:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
N071753d.
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Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is LI County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ ou Re c der
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
adhere the property is located during the twelve(12)months before March 31 of each year the deductionth
See reverse '.- for additional instructions and qualifications. COUNTY AUDITOR
Applicant r_/ contract,/ — /1c.# `' ■J4.t a,v72 - (
T District 1,. , ,„T` llamber!7alodesa b7n/ Record nwnber Page P
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the see
assessment date,current year assessment date,current year date of ap legal or equitable owner?
apple-stop ❑ Yes ❑ No
If no,what is his/her exact stare of interest? If owned with someone other than spouse,indicate with whom
If name on record a different than that of applicant indicate below. Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobie Home(IC 6-1.1-7)
Name of mortgagee or contract seller /D id .2.,(
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or otter owner or holder of mortgage a,n / 9 /J(//0 j^7 —V4 J- // e 2.54 /9
Address er dress of assignee(numb and street city,state,and P e)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes. ❑No
I • 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 aedit 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 -
g ty County Date(month,day,year)
•
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is fled
/ Signature(owners fuiname) Date(luwadr,day,year)
tX' Fu m address of an nt(num and street.dl�spte,ar�2(P code) r n
oo-- /0€40A ), J2t `/7Go
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street ary,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000. .