HomeMy WebLinkAboutMortgage_WilzbacherSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S J State Form 43709 (R4 / 10-01)
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� PrescribeA by Department W Loral Govemment Finance
INSTRUCTIONS: � Fif .Mark
To be filed in person or by mail with the County Auditor of the county where the propeRy�' I�oc �d� �
Filing Dafes: 1) Real Property: During the 12 months before May 11 0l the year the ded���F on i o e eCtivs.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 o the year the deduction is to be effective.
See reverse side foradditional instiuctions and qualifica6ons. r'jQi � 9 20�3
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Applicant(owne�orcontrac er-see2strictionso v e de) L""v_ '`��J
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� GIESON COUhTY AUD�TOR
Tauing Distrid Key number / I desuiption Record number l��
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4�1 / 2_OO a I 5' - �� Page number /D�
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Ass sed value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year 'March 7, curtent year owneR ❑ Yes ❑ No
SDOO
If no, what is his / her exad share of interesl? f owned with someone other than spouse, indicate with whom.
If name on record is dif(erent ihan that ot applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hortie (IC 61.1-�
'�me of moAgagee or contrad seller
Address of mortgagee or conVad seiler (number and st2et, 'ty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 Q 20 20 20 'J - 20 20�� 20 O
P a�- � P P �°
Signature County Auditor Date
�'/ We certify under the penalty of perjury thal the above and foregoing infortnalion is true and corted and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur owner's /ull name) Person aulhorized by duly executed Power of Attomey
�, or by IC 6-1.1-12-.07
F II resi ent address of applipnt Address of authorized person
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