Mortgage_Schneider STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
t. '' FOR DEDUCTION FROM ASSESSED VALUATION lCounty Township Year
,�1 State Fonn 43709(R1311415) �Ly3� 1 Wnion 9O tX
�- Prescribed by Department of Local Government France \/•➢V 1 IVA_■) (/�V (V
INSTRUCTIONS: _ File Mark
lb 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 orposfmarkAuditor
ed with the County or County Recorder of the county where the properly is 4 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 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 quafdreations.
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T�9.n pin Key nu I
: ��--2J -30 -2�. Ala c"7f l r j.2 number Page 2
Assessed value of real property as of age Contract indebtedness impairs of Mortga 1 Contract ebtedness infr as of Is the applicant the sole
accxcmem date,current year assessment date,current year date of �O ooO(�J I or uitab'e owneN
�— Yes 0 No
lino,what is his I her exact share of interest? If owned with so other teen spouse,indicate with whom
If name on record is different than that of applicant,indicate below s property in question:Annually Assessed
Real Property 0 Annually Aeexsed•
�
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .`
}' 1 {" `,(�1 k t
VAddress of mortgagee or contract seer(number antl sree-t tlyy statte,,(a3"ndd ZIPP ccode) ,
DDD1��'
Name of assignee or other owner or holder of mortgage t% 1,p18
( �L
Address of assignee(number and street city,state,an V
Al
Does applicant own property in any If yes,what mu s, en req )1�-.. of deduction
other county _/ v / ? V�\ ..
in Indiana? ❑Yes ❑No Drawer NO (�`- �N G�
A person is not entted to this deduction unless bi 3d ifskib ness that is recorded in the county
recorder's office(including any home equity liner I S 'is the basis for the deduction.
Card NO.
Deduction approved in the amount of
20 20 20_ 20_ 20 20 20
Signature of County Auditor County • Date(month,day,year)
I 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(owner's fun name) Date(mongr,daarl�
//V`` FR3rexnt_ address oFSfxant nu su.._)Sate.and t�a �_/� �"L7
Person authorized` by duly executed Power of Attorney or by IC 6-1A-12-0.7 ,mow'�V''^I f Y' `1 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$10,000.