HomeMy WebLinkAboutMortgage_Schmett .s,•: *oa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County - Township Year
t, y1G FOR DEDUCTION FROM ASSESSED VALUATION
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4'L`s °�f=f= State Form 43709(R13/10-1� / �� 1\a)v) ZO \I
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,,,�' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by maiL ;Form filed with:
Filing Dates: 1) Real Properly 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.
Ap ' t(owner or ntract buyer-see`� n�s/o1n rgverse side)
an Flf\A
Taxing ct��0 Key nurr r!legal`e ip L 0 0ID 02 3,6� ��� Record rum Page number .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag /Contract indebtedness un as of Is the applicant the sole
assessment date,current year assessment date,current year date of a plica' _ legal or equitable owner?
����0 , 0 Yes 0 No
If no,what is his/her exact share of interest? If owned with so ne other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: • i e property in question:Annually Assessed
• le Real Property 0 AnnualMobilelyAs Home ss ed
a 1.1-7)
Name of mortda or contracttssell5
\44\tC__ \--- --COW .
Address of mortg e or contract seller(number and street,city,state,and ZIP code) --
Name of assignee or other owner or holder of mortgage D I'a�v C I- �i O
Address of assignee(number and street,city,state,and ZIP code) Card N O.
Does applicant own property in any If yes,.what county? Wile ted If yes,state amount of deduction
other cou
in Indiana?y ❑Yes • • 0 J No
A person is not enfitI s, •duc r,• n` ,-person has a t tedness that is recorded in the county
recorder's office(incl;•i gJny„o,e r:•u' I s if credit that is re T __a,-,:,,,n ucr s omce)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the a �11 Jit 7 2019
20 U V V 20 • 20 ' 20' 20
Signature of Coun i
Uf AU ITC1 Countywas 6� Dalrtidettypfr)
�1I11,J1�I/We certify under the penalty of perjuryy that the above and foregoing information is and correct and that the applicant a rdent of Indiana and
owne /contract buy of the aforementioned property on date application is filed.
S' et�r wner's I/na e) Date(m nth, y,year)
)(-*
1P 19
Full esi nt add of licant(n.umkererandstre c' ,sta ttlintiZIP code)
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7r Date( �h, yar)
1
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.