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HomeMy WebLinkAboutMortgage_Schoppenhorst �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS tor-, FOR DEDUCTION FROM ASSESSED VALUATION County /t Township / Year cii) State Forth 43709(R13/10.t5) \9S f y� �/I� - 1�$ �()Prescribed by Department of Local Government Finance JJI y� v�1 �(� ��Vil+/llN' ll File Mark INSTRUCTIONS: To be fired in person or by mail. Forth filed with: Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought g Must be filed or poffinarked with the County Auditor or County Recorder of the county where the property is County Auditor located on or before January 5 of the immediately succeeding calendar year. County Recorder 2) Mobile f Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county whem the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. Applua owner or contract buyer-see restrictions on reverse side) niOSya cSc en hOk\ Swan D' trrct Key /legal description Recarc number Page number G� - 14- - 3c�4 -00 0 . 6�1� -00� ,cnlR 362r Assessed value of real p of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ptinm the sole assessment data,current year assessment date,current year data of legal o equitable owner? t /�V O��J ©.Yes ❑ No if no,what is his/her exact share of interest? If owned with someone other tSan spouse,indicate with whom / \ If name on record is different than that of applicant,indicate below. Is'the �pr property in question:Annually Assessed Name of mortgageeHOrre(IC 6-1.1-7) or contract seller (1 ; rei J Address of mortgagee or contract setter(number and street city, ate,and ZIP code) DEC 31 2018 Name of assignee or other owner or holder of mortgage Address of assignee(number and aoec;dry,state,and ZlPcode) GIBSON COUNTY AUDITOR Does appnlicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction property for in Indiana? ❑yes ❑No current year?_❑Yes 0 No A person is not entitled to this deduction t -} retract indebtedness that is recorded in the county recorder's office(including any home equ Drawer \t 0 'Y 0 j O p that is the basis for the deduction. Deduction approved in the amount of: �� Card NO. OS S - 20 20 - 20' 20 Signature of County Auditor I 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. XS g�nature hers full name) Date(month,day,year) 1 � �� _ tea— 12 -31— -S . ,5itll resident ad� of�\fican (num rand street,city, ,amlLPicrI ` �� ri • Person authorized by duly executed Power f .1-12-0...7-;�-}1``1,V / 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. .