HomeMy WebLinkAboutMortgage_Wilson"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn 43709 (R71 / 6-09)
�' �.a � PresaiEed M �eParVneM W Laal Govemmenl Fi�nce
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAuditor or Counry Recwde� o( the counry where the properry is located.
Filing Dates: 7) Real Properry: Must file dunng fhe year for which the deduction is soughf.
2J Mo6ile / ManuFactured Homes not assessed as Real Property: Must file dunng the fweNe (12) months
befora Maich 31 o(each yearthe deduction is sought.
See reverse side 7or addiLOnal i structions and qualifications.
AppGrant ( r ar a yyyer see -' ns m reverse side)
fi ,n/ �
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T �s Key number I leg I Ocui fion
_ / �-/ _ /-Gl� /. / � 5� GY� �
AssessM rWue popaty as o( I Mortqage / Contract ude6teOness unpaiE az of Mort9age I ConVact'vWebteMe_ts
, Martii 1. ar�art Mar� 7, wrteM year date of aPP�� n n _
n0. wha� 51tis l lrer exad
nafrre m fam�tl is tlifterer
Nartre ol rtrortgagee a mntracl se4er ��
�
Addres W nwrtgagee or canttaG seAer (number and sb
Name at assignee w athrl awner or halder ot mortgage
/
AAtlress ot assignee (number eM street �: �. antl
Ooes applimnt own yoperty in any oNer
ca,uri�maiaria� .-, ,—,
DeducGOn aPW� in 4re amou� oE
'4 �y. stl+e. aM LP code)
IP cade)
y�s, what count�t
COUNTV
20 � 20 � 20
Npy @a���.
❑ counry Recorder
� �
G��� NTY AUDiTOn
mrE numOni P e numOrl
U
pa's7 as of Is Ihe eP�+t ihe sole
tegal u ewftaMe ovmeR
� ❑ Yes ❑ No
�e property in puestion:
Real Roperty ❑ A
r_ _' --_.- -
�cQ �UI-� �u A G�,Sa,v
Whaf Taprx D/� J/ O/ /
6 (f/ /
20 � 20 _ � 20 � 20
Sig�ahae W CounbAWimr I Counry I Date (rmitti. EaY.Y��
I/ We certify undu the penatty of perjury that the a6ove and foregoing infortnalion is We and cortect ark Nat the applinnt is a residenl of IrWiana aM
owner I contracl buyer of ihe afaementioned property on date appliption is filed.
S+9�MIa (owne(S hN famW . Dale (month, daY. Yea�
fWl resident address ol aDP��nt (numDerantl sLeet, dry, state, and 21P ootle)
`J'�LCU� n✓' DGckland c�ty �
Person autM�rsed Dy OWy ezecuted Power allvtorney w by IC 61.1-12-0.7
Pdtlress of auCror'¢ed primi (numberaM snee4 mY. �re. and LP mtle)
Date (marlh, da): Ysa�