HomeMy WebLinkAboutMortgage_Schafer (15) .0,: �4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;; - h: FOR DEDUCTION FROM ASSESSED VALUATION
�, = State Form 43709(R13/1015) ` `n, 2
,�? Prescribed by Department of Local Government Finance ✓� •' "" `
.e,,
2-\
❑ 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.
App( ic
li nt o Qer or contract bu r-see restrictions on reverse side)
Taxing District Key mbar/legal description Record number Pag umber
(� ` - 26 -oS-s�-- -oc 2--O 00 , 6 9-6-o (9- . 2 016 61
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract.indebtedness unpaid as of Is the a..li•- t the sole
assessment date,current year assessment date,current year date of pli on 3... legal or=; table owner?
`f Fr Yes ❑ No
If no,what is his!her exact share of interest? if owned with so e0ne other than spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: I e property in question:Annually Assessed
Real Property 0 Annually Assessed
- Mobile Home(IC ti 1.1-7)
n :'j - : : ,
Nik
Name of mortgagee or niract seller L
Address of mortgagee or act seller(number and street city,sta ,and ZIP code)
FEB 2 6 2U24
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) ��- VorfoR.
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No current year? ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on fhe 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 20 2 9 20 ' 20' 20
Signature of County Auditor ounty • Date(rycpth, 1.-21,,y,L0
I/We certify under the penalty of perjury that the above aand ffororegoing information is true and correct and that the applicant i!s/ esidIndiana and
Xig owner!contract buyer of the aforementioned property on date application is filed.
Signature(owner's fall name•Y Date,(nr,Qn/ ,te r) T
ull resident address of applicant(number and street,city, te,and ZIP code)
Person authorized by duly executed Power of Attorney 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.