HomeMy WebLinkAboutMortgage_Schmitt f ,_r;, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Townshi —�Y,ear
:S FOR DEDUCTION FROM ASSESSED VALUATION A,..S. State State Fonn 43709(R13/10.15) L
Presrnbed by Department of Local Government Finance
INSTRUCTIONS: g(' 21
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 properly is , ❑ , ;i - •ditor
located on or before January 5 of the immediately succeeding calendar year. .; �I� fir( gar�rdar
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the N •U NT? ' d t71 T O K
where the property is located during the twelve(12)months before March 31 of each year the deduction rs t
See reverse side for additional instructions and quafdications.
Applicant(owner or cco)ntract buyer-see restrictions on reverse side)
Taxing District�*\/�-(�✓-' S number k legal description .v C�`P �V�•,��C�i Record n r Page number
ss property as of Mortgage (Contract indebtedness unpaid as�of Mortgage\23 -0, C) unpaid as Is the applicant(�
assessment date,and year assessment date,anent year date of application �1 legal or equitable owner?
I- S 1 !ROD , t ❑ yes 0 N
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 iei—. - - .-- u� Is the in question:Annualy Assessed
/� - I U. �m�Zln2(,�c., Property ❑ Annue Horn (IC 6
�I Motile Home QC 6-1.1-7)
Name of mortgagee or contrail seller
�.e r Pt r(,e /l tootz, g mist,
Address of nrrtgagee or contact seller(number and: 7t LA-1 SCk 4
Name assignee or other dg
er owner or holder of /8^�/5v
Address of assignee(number and street city.state,and ZIP code)
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 anent year? ❑Yes ❑No
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
recorders office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount o:
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.
$nature( come / Date(month,day,year)
FU ad cea .,er -...we..,... -' �.�.., in.01P code) ..vS/3/�ZD/gam
103 . -�.,.• ` _ 1 -
11 `" - '-1 • ID
P n authorized by duly exec taed Prover&Attorney or by-IC 6-1.1-12-0.7 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 S1 ci,00a