HomeMy WebLinkAboutMortgage_Schroeder (3) a.> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: .. •
File Mark
To be filed in person or by mail. Fonn filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought n :�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property I ❑ f.r
located on or before January 5 of the immediately succeeding calendar year. 8 J
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county tin ecerder
where the property is located during the hyena(12)months before March 31 of each year the deductron is sought5 E P 10 2018
See reverse side for additional instructions and qualifications.
AppVt(ownerat contrat see )
0 s Ot_rn 0 5chlreed2.r . �
Taxing District Key number/legal description Rec rd a lki r„
, ioh(\San. a to s t9- �s-tico- ooa ,-J o9- O ay_ Glr3so Our) ifl°ebR
Aceoevy value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessneta loth,amend year assessment date,arrant year date of application legal or eequi�tab.'e owner?
4 O Cock L7 % ❑ No
I1 no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record N different than that of applicant indicate below?. Is the in question:Annually Assessed
Rupc,ly ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and atket dry,state,and ZIP Code)
Name of assignee or other owner or(alder Of uRAtgage
Address of assignee(number and street dry,state,and ZIP code) Drawer NO
Does aar t own property in any If yes,what county? What Taxing District? Card NO.
deduction
othrin Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the pa 1 the county
recorder's office(including any home equity line of credit that is recorded in the oou , _____. _.,....,,,?oral u use pass ror 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 love and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(mom],day,year)
y
Full resident ap 6' t(number and street city,state.and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(nandh,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$10,000.