HomeMy WebLinkAboutMortgage_Schaeffer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E"' l FOR DEDUCTION FROM ASSESSED VALUATION "" "
•---Ai..S State Form 43709(R13/10-15)
—- Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: File M rk0
To be filed in person or by malt. fiylNJf✓wEph
Fling 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 pro i County Auditor
located on or before January 5 of the immediatey,succeeding calendar year. 0 190anty Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th my C 3
where the property is located during the twelve(12)months before March 31 of each year the deduction is scout
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see re&traia,a on reverse side) S
ft
SOc�� 4r1 d �Ir1A1n SC E1CL�CCe :v
NO U
Taxing Dis�tr,ict\ Key number I legal Record n Page number
o�`�{ a AS 1 . k�—c3-'3 - `403 - c cO. c - 0o� Go " IS 48 z8
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,aurerit year assessment date,current year date of application legal or equitable owner?
0 Yes 0 No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
H name on record is different than that of applicant indicate below is Ne inquestion:Annually Assessed
Property 0 Annually Assessed• Mobile
Home(IC 6-1.1-7)
Name of mortgagee or contact seller
a � , .
Address of mortgagee or co seller( tuber and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No on �n ❑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:murder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at.
20 20 20 20 20 20 20
Signature of County Auditor County • Date(month,day,yea)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
er/contract buyer of the aforementioned property on date application is filed.
S" (amseA fuD e) Date( with,day,year)
\ 1y
am
F"
Pr 1 ,Z5 pp5pnt(n I city,state.and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ay,slate,and ZIP code)
The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed S10,000.