HomeMy WebLinkAboutMortgage_Schaefer to STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:=_: FOR DEDUCTION FROM ASSESSED VALUATION
�.'- State Fomu 43709(R13/10-15)
FILE
"-41--• Presented by Department of Local Government Finance IF LLt
INSTRUCTIONS:
lb be filed in person or by mail.
��1-��rpp fi�ph
Fifing Dates: 1) Real Property.Must be completed and dated in Me calendar year for which the deduction is sought APR u L U l8
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is L.1 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ■ . u, r-in ber
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the coup•,I , __• -N
where the property is located during the twelve(12)months before March 31 of each year the led -..
See reverse side for additional instructions and qualifications. lid a \ COUNTY AUDITOR
App&rant(owner or contract belles'-see restrictions on/reverse s ink)1 , / /C]A— P7'3 r
Taxing District CX 6 1 l - ✓VO COQ.a 13 - A s Reid I�`{�ger /0 r
Assessed value of real property as of 1 Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid/as�ofUf Is the applicant the sole
assessment date,amend year assessment date,cement year date of app Ton Cr) legal or equitable owner?
If ro,what is his/her exact share of interest? If owned with sort�M mhrethan ❑ Yes ❑ No
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 Home(IC 61.1-7)
Name of mortgagee or contact seller 111/1I� J1
Address of mortgagee or contact seller(number and street city,state. ZIP �)
Name of assignee or other owner or holder of mortgage 11� ,j'
Address of assignee(number and street dl('�,.r\S�oe'A(U`rP _ G�G--Q, `fr 01. a rv,,kA
Does applicant own 3,�r..Q-2T C Y o
Doer county property in any If yes O on been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No WI Soo •bp u ❑Yes" ❑No ,
A person is not entitled to this deduct of 3- 1 1 . l g =tract indebtedness that is recorded in the county
recorder's office(including any home el ),Q 17-6_ to L L I that is the basis for the deduction.
Deduction approved in the amount ot.
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/co ct buyer of the rementioned property on date application is filed.
Si ( �ffullll'n7ame) Date(month,day,year)
FWlrr�ptl � � (numb(and " ,Istate.ap4L ,ode) r� ( 16 �� y a�4-�S�
Person authorized by duty executed Power of or by IC 6-1.1-12-0.7 \�)V_l "L 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 410,000.