HomeMy WebLinkAboutMortgage_Schmitt (16) 0_11144 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'' ' FOR DEDUCTION FROM ASSESSED VALUATION q3C)It2[ 2020
S+ /gState Form 43709(R14/1-20) "\
`..", Prescribed by Department of Local Government Finance& File Mark
INSTRUCTIONS: Whe)`'.0 `/ I �1` �-1, �`�'(�To be filled in person or by mail. 1 F rm fled with:
Filing Dates: Form must be completed anhe calendar year fo `fr • the deduction is sought.
Must be filed or postmarked with the County Auditor or Co Recorder of the county where the
property is located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Amanda N.Schmitt
Taxing D.L.,51.1ct Key number/legal description 26-22-07-100-002.531-024/6207 W Record number Page number
�� Highway 68 Cynthiana, Indiana 47612 .CjO L_S-cil (D
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 ore itable owner?
$80,000.00 es ❑ 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 t roperty in question: Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Community State Bank of Southwestern Indiana
Address of mortgagee or contract seller(number and street,city,state,and ZIP code
220 S Lockwood St, PO Box 280, Poseyville, IN 47633 F
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) NOV 1 9 2020
Does applicant own property in any If yes,what county? What Taxin District? as-this-deduct ben requested If yes,state amount of
other county property for deduction
in Indiana? 0 Yes 0 No Tv af'j'Zg�? es 0 No
Son t e per.1. .
A person is not entitled to this deduction unless the person has a ba eon he person's mortgage or coot 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 he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 fie 20 20 20 20 20 20
Signature of C .•itorrn1 County \ ^ Date 1\On}'hday,till lino
I/We certify under the penalty of perj t e above a d regoing information is true and correct and tha the licant is a resident of Indiana
and owner/contract buyer of the afo ementioned property date application is filed.
Si tr (owner full C mq 1 Datr I(m�nth,day,year)��
Full re§ident a dress of appli nt(number a d ee city,state,and ZIP code) !tl/J1 MIL)
PP tY.
6207 W Highway 68, Cynthiana, IN 47612
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 ears. d a fine not to exceed$10,000.