HomeMy WebLinkAboutMortgage_Wilson (10)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
°. ' FOR DEDUCTION FROM ASSESSED VALUATION �� Co�} Township Year
�. �� StalE Fortn 43709 (R4 / 10-01) IT"�
.a. Ld
� Presai0e0 by Departmen� U Lacal Govemment Finance .FLJ
APK '/
INSTRUCTIONS: Fil ark
To be filed in person or by mail with the County Auditor o/ the county whe�e the prop is located
Filing Dates: 1J Real Property: Dunng the 12 months be(ore May 11 of the year l6e d��cyoais� e°e��"�e_ �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and �i�h�3}tol.tre�"year �fhe�deduction is to be eHective.
See reverse side /or additional instiuctions and qualifications.
Appli t(owner or contract uy - see restncBons o reverse side)
Taxing District Key number / legal description Record number �
_� Page number � ��
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March t, curtent year March 1, cunent year owneR �es ❑ No
.J 000
If no, what is his / her exact share of interest? I( owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is the pr perty in question:
eal Properry ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contrad seller
`��3
Address of mortgagee or contracl seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applipnt own property in any other If yes, what county? What Tauing District? Has this deduction been requested on
county in Indiana? property for current year?� Yes❑ No
- [� p/' 3� . I COUNTY AUDITOR
Z .lb
DeducGon approved in the amount of:
20 Q 20 20 20 � 20 � 20 �� 20 �
r�o � P P P
Signature County Aud'Aor Date
�'/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owner's /ull name) Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full res dent address of appliqnt Address of authorized person