HomeMy WebLinkAboutMortgage_WildtSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 nshi r
::--
� FOR DEDUCTION FROM ASSESSED VALUATION
• Sfale Fartn 93709 (R71 / 6-09)
�' ,w J Presr+ibetl by Departmerit oi Local Govemment France
' a� 11
�srRUCnorvs:
be filed in person w by mail with the CountyAuditw or Counry RecoNer o( the county whem the pmperty is located. ����w��
� Filing Dates: i) Real Pmperty: Must file during the year (or which fhe deduclion is soughG � Eitor
2) Mo6i7e / Manulactured Homes rat assessed as Real Prapeny Must file dunng the fweHe (12) month� �BS N 0 NL�dU r
before March 31 of e year fhe deducfion is sought � �Y1�C�Q9$F
See reversa side !or add'Rional ins � and qualificafions.
App5cant( rorcorit2Ubuyer ^ a^/ey€%seisde)
amerit yrar
3t is ha / ner exa�i
_ M�ortapag-e - ao _ a . 3 -ea
Mam}i 1, / Contract iMe6lednev unPaid as of Mor�gage / ContraU im
w�rent yeer date of appfi�tian .
nartie m remd's Cifiemnt Nan ihat o( aPP��I trWUate 6ebw.
Name of rrortgagee m m�tract seller
AddresS Ot mort9a9ee or wntract SeDet
Name a� assiryiea or otM! ovmer or
�`iI � �
��
���
�
li�ant wm property in any oNer
InCiana?
❑ Yes ❑ No
app�ove0 ui Ne amount aE
20 � 20
sig�anne w cacib nwaor
�
I I We certiry ufWer Ih�
ownerlcontraU buye
Si9na9+� (own�S.luN narm
�ix�rri,�
FW asidenfaq dap�
C /
PersonautMtved Cy Outy E
If yes. what county+
E'i9
If o�wm.d wiM someone dher Ihan spouse.
� y,� /� -a ,d
What Ta�d�g Ostria?
)UNTYAUOROR
20 20
penalry ot perjury Ihat ihe above arid foregoing infortnalion is We anC correU an
of Ne aforementionc�.9r�erty.pn date applicalion is filed.
rn Cy IC 61.142-0.7
authortred persai (number aM street cAy. sb(e. enA
Is Ne epplircant Ne sde
Iegal or eQUitade o�vnel�
❑ Yes ❑ No
with whom
re pmperty in 9����: �nua%ASSesud
Real ProPenY ❑ %����Y �
/, .�9>�/%�,
O�rtY
❑ No
�— � �e�
��tia,°�'� °ZQ�.1������...
`a" e, ,�O ... . ; .r�
p � �a,�0..1•��'''�
\�' � � j
C�� � �