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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Iz FOR DEDUCTION FROM ASSESSED VALUATIONState Form 43709(R13/10-15) 0' Prescribed by Department of Local Government Finance �1�1 - - J
a: ��S `t Y K C File Mark
INSTRUCTIONS: `
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. y Count Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
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)
Schmitt, Sandra S. & David E.
Taxing District Key number/legal description Record niber Page number
Ft. Branch 26-19-18-302-000.682-026 a0a -__ l&QS
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is s the applicant
equitable at the owner?sle
assessment date,current year assessment date,current year date of application 9
$165,000.00 E1 Yes D 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: f ILE
1 3—l�Is the property in question:Annually Assessed
J I❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller APR 1 8 2022
Heritage Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP co e
5388 Old State Hwy 66, Newburgh, IN 47630 Gt�sso
Name of assignee or other owner or holder of mortgage N COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? Has this deduction een requested If yes,state amount of deduction
other county on property for
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 ract 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 ec1 20
Signature of County Auditor County ` `O^ D Imoin4�dy,1Cs9-,•
Mom( c� v1s 0` J u
I/We certify under the penalty of perjury that the above and foregoing information is treJand correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign lure(o'J//rff) r) /) /goirrt Date(month,day,year)
04/14/2022
Full4 ident address of applicant( umber and sues 70�/,city,state,and ZIP code)
703 East Tretter Park Drive, Fort Branch, IN 47648
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.