HomeMy WebLinkAboutMortgage_Schmidt (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
4 & FOR DEDUCTION FROM ASSESSED VALUATION
F- 1---\o".') 201
``'` "'� State Form 43709(R13!10-15)
i -so
`,, � Prescribed by Department of Local Government Finance i_6
INSTRUCTIONS: File Mark
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 property is 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 qualifications.
Appli t(owner or con buyer-see restrictions reverse side
Yl S'�'o CIA Ulm 1
Taxing Distf I lir lel!? tuberl' al des on Record number Page number
• a -1�o -3d -amoo 0I-S^-O2� 15 2 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Con ct indebtedness unpaid as On_Is the a cant the sole
assessment date,current year assessment date,current year date of ap ' do _legal or itable owner?
pYes ❑ No
If no,what is his/her exact share of interest? If owned with some() a other than sp6use,indicate with whom
If name on record is different than that of applicant,indicate below: I property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag contract seller tk FILE
Address of mart agee r contract seller(number and street city,state,and ZIP cod
Name of assignee or other owner or holder of mortgage 1 V O V o 6 Q Ig
Address of assignee(number and street,city,state,and ZiP code)
thisd !
Does applicant own property in any If yes,what county? What Taxing District? HasGs this de uclroircb ?lk u9I—tEtAs,state amount of deduction
other county on propertyfor
in Indiana? El Yes 0 No currrener? ❑Yes D 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
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
•
20 2 20 20 • 20 ' 20' 20
Signature of County Auditor 14
(1I .__II:::)
Coun l\o.1 ,1 Date(m nth yEz
I/ e certify under the natty of perjury that the above and foregoing information i e and correct and that the applicant s a esident of Indiana and
er/contract buyer of the aforementioned property on date application is filed.
Si iie2tTT7j4A(Llvh
A{ Date(rripnu b nds/tie ,city,sly, n Z/Pcode It I 6
3_6_70
Person authorized by duly executed Power of Attorney of by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) t
The penalties for perjury can include imprisonment uo to two and a half years and a fine not to exceed S10.000_