HomeMy WebLinkAboutMortgage_Schroeder STATEMENT OF MORTGAGE OR CONTRACT Tyr!
Asa� ourtty Township Year
FOR DEDUCTION FROM ASSESSED VALUATIOT1
-? !-• State Form 43709(R13110-15)
`— Prescribed by Department of Local Government Fiance APR 1 S 201
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Properly.Must be completed and dated in the calendar year for wh'. -d-._...,:.,-r+ sought
Must be filed or postmarked with the County Auditor or County Recorder•,"'.-.r1ai•r'--I.U Iet `ty is ❑ County Auditor
located on or before January 5 of the immediately succeeding cssi WtrCOUNI ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant.._ or contract buyer-see restriction on reverse side)
5 Taring Drsfic Key legal piton Record number Page number
/JaGai,a,it,,.. zo -0 5 5 7/0 V oaf) 8o 8"oil l 5` / 539
Assessed value of rea/piroperty as of Mortgage/Contact Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessn%rd date,a9an sear assessment date,current year 2, date of application legal or equitable owner?
Z 2 to L, r-f 91 . ❑ Yes ❑ No
If no,what is his I 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 Pmpeity ❑ Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
Address of mortgagee or seller(number and sheet city,state,and ZIP code) �,,hn-,-�—� �—�-
Name of assignee or other owner or holder of mortgage �n..
IS- I537
Address of assignee(number and street dry,state,and ZIP code)
Does applicant own property in any If yes,what county? Wnat Taxing District? s xtion
other county r
in Indiana? ❑Yes ❑No r -
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co:Alas.(indebtedness that is recorded in the county
recorder's office(ocluding 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 aforementioned property on date application is filed.
Signature( s Lull name Date(month,day,year)
I . X���,
Full resident address of applicant(number and street,city,state,and LP code)
Sr■ Sr2 a5 L4.i/tia,/
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steel,city,state,and ZIP rude) -
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.