HomeMy WebLinkAboutMortgage_Wilkison (5)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ : FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm A3709 (R71 / 6-W)
�' ,,,� PresaibeC by DepartmeM of Loral GovemmeM Finance
INSTRUCTIONS:
To be filed in person w by mail wiN Ihe CounfyAUditw or Counry Recorder o! the counry where the property is located.
Filing Dates: 1J Real Property: Must fife dunng the yearlor which the deduction is sought
2) Mobde / Manu/acturcd Homes not assessed as Real PropeRy: Must file dunng the hvelve (72) months
6efore March 37 of each year the deduclion is sought �/eS '
See reverse side (or addtional instnrctions and qualfications. �'i'
�r�y rwcontracfbuyxr- re�erse�p e) i
7% nCL.� �� mcnl/a. �. � ,ll��i�srlk�
U Y�.� — V - —
1 YaWe of real pfoperty as Of Mwtgage / Contract u
anenl year Martl� 1, n�rtent yeer
tt narne m 2md'a Eiflereni Nan Nat W aDP�4 mdinte Gelmr.
Name ot rmrt�asee « mnvxt uuu C..JJ/ /
ll
Mdress of rmrtgagee w mntrad sr�er (nwMer ar
Name af assignee w athu awner or holder o1 rtrort4
AdE�ess of assignce (number arM sbeet �#Y. s+ate,
Does eppliont own yoperty in any wher
munry in Indana? ❑ No
❑ Yes
appfoved in tlre amouM ot
sbte,
Z/P code)
If yes, what muntyl
�. 3 -oo/ 'G .�a U
1 as of Mortgage I Conbad indebiedness unpaitl a d Is Ihe epd�t the sole
tlate of ap legal or eQuttade o.mM
U ❑ Yes ❑ No
IF awnad with e er than spouse, fM'uste wiTh whom
Is e WoGertY in OuesCOn: Mnua�y Assessed
Real ProPeKY ❑ %���N �
Wltat Ta�dn.
20 20 2f1 _ 2� _
SignaNre W CounNAUEitu ` 11 Caunry
I I We certify under ihe penalry of perjury that Ihe above and (oregoing infortnation is We.
owner I contract buyer of the aforemeptioned property on date appliption is filed.
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person (num6er an0 sbeet �: state, aM Z!P cnde)
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