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STATEMENT-OF MORTGAGE OR CONTRACT INDEBTEDNESS County —ta�/nship Year
j _' „ FOR DEDUCTION FROM ASSESSED VALUATION �-.
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�.J' State Form 43709 /
�` / : Prescribed by Department of Local Government Finance RECEIVED it
N File Mark
INTRUCTIONS:
lb be filed in person or byimail. 31r•Ock6A-vId JUN 11 20 For 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kurtis E. Schmitt and Stephanie E. Schmitt, husband and wife
Taxing District Key number!legal description Record number Page number
Johnson 26-23-08-300-002.609-024 2D 20 2316
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$151,500.00 E Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First National Bank of Carmi Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FILE y,201 E Main St., Carmi, IL 62821
Name of assignee or other owner or holder of mortgage J U N 112020
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? GI;I'So �y�i Aour'V R If yes,state amount of deduction
other county on propertyyi"or
in Indiana? ❑Yes No current year? ❑
❑✓ Yes ❑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 20 20 20 20 20 20
Signature of County Audito M County 1,ScY1 Date(mon ,da, ear)
I,We certify under the penalty of perjury• - •- above and foregoing information is ru and correct and that the applicant is res ent of Indiana and
owner/contract buyer of the aforementioned property on da - application is filed.
Sign ture(owner's full name) Date(month,day,year)
E ,LIA,,, 9, 774 Y/iQ 06/01/2020
Ful resident address of applicant(number and street,city,state, .• IP ode
11760 S 50 E, Haubstadt, IN 47639
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.