HomeMy WebLinkAboutMortgage_Schmits (7) , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-= - FOR DEDUCTION FROM ASSESSED VALUATION I
.r} ��,vi State Fonn 43709(R13/10-15) a S 011 1II ,nir�./� W lC1
S rem' %a' Prescribed by Department of Local Government
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.
Applicant(owner or con l qtbuyer-see restrictions on reverse side)
\ho-' & • ,V1Cfn Sc)fM1
T gDistrict Key number/legal description Record number Page number
I,,1) 2 6—1 q -1 -L.-Yak)0-0 02. u 3-7 —0 2... ---- 2o- LI 40\—
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/ •ntract indebtedness unpaid of Is the applicant the sole
assessment date,current year assessment date,current year date of a• on tDo- legal or e i ble owner?
�� es 0 No
If no,what is his 1 her exact share of interest? If owned with so ,-•ne other than£pouse,indicate with whom •
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
eal Property 0 AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contralier \�!�`9
Address of mortgagee or contract s ller( u er and street i.a}I,srate,and ZIP code)
sc m1�rs,¢ /i s H y;
o1 r�
..
Name of assignee or other owner or holder• r g� ® *,* � ,ovoid in
Address of assignee(number and street,city,state,and ZIP code) f
DEC 0 6 2019 /g_ qt/UJ`
Does applicant own property in any If yes,what county? What Taxing Distric date amount of deduction
other county
in Indiana? ❑Yes 0 No •
•
A person is not entitled to this deduct* 0 a bal nce on the person's mortgage yr LA........—....._..__ !is recorded in the county
recorder's office(including any homy trq 1 in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 0 20--,1(3..1.) 20 20 20 20
Signature of County C vv� (-iiti County • Date
1 m qt day, fry`
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant i sla resi nt of Indiana and
er I contract buyer e aforementioned property on date application is filed.
Signa (owners full ram)c
�`/, Date rrildbmittlI1
Full resident address of applicant nu and stree city,sta nd ZIP code
SQ&1 E 57o t.Ls pi- u - in - 41-6 'a
Person authorized by duly executed Power of Att6mey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for oeriury can include imprisonment un to Iwo and a half treats and a fine not to exceed 510.000.