HomeMy WebLinkAboutMortgage_Wilcoxone� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i-° : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�J Stale Form 43709 (R4l 70-07)
�� Prescnbed Dy Depannent of Lotal Govemment Finance �
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INSTRUCTIONS: NOV O=� L��L a`�`
To be filed in person or by mail with the County Auditor o( fhe county where the property is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months before May 17 olthe year the deduction i�to be elfective.��
2J Mobile Homes assessed under IC 6-1.1J: Behveen January 15 and March 31�ofGthe year_ e deduction is"to t% eflective.
See �everse side (oradditional instructions and qualifications. �`� G!°SON r � j�,t.qi �D� �R !
Applicant or cohtract 6uyer - ee 'ctions on e rs si e) „/�
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Taxing Distrid Key number / legal description Record number D�
� /nO�D���Q -� Pagenumber / �
C./ (D
Assessed value of real prope y as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1 rent year owner? ❑ Yes ❑ No
�1 �f o �o
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 lhan ihal of applicanl, indicate below: Is the propeRy in question:
O Real Property ❑ Mobile Home QC 61.1-�
�3me of mortgagee or contract seller � �
Address ot moAgagee or contract seller (number and street. city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 f�,�_ 20� 20 fL`S 20 � 20 rL 20 O i' 20�_
r�-�a �,- l� P � P
Signalure County Auditor Date
�/ We certify under the penalty of perjury ihat the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur wners full n me) Person authurized by duly executed Power of Attorney
" � or by IC 6-1.1-12-.07
Full r i ent addr of ap icant Address of authorized person
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