HomeMy WebLinkAboutMortgage_Wilkas^� STATEMEN7 OF MORTGAGE OR CONTRACT INDE
�_ FOR DEDUCTION FROM ASSESSED VALUATION
Slale Form 43709 (R70 H7-0e)
` w. � PrasuibeC by Oeparimen� dLaW GovemmeM Firence
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INSTRUC710NS: FI8 MaAc
xear,�a;��,��way���mn,eco��yaw;m.ama��rywnaremaa+oaBnr�sro�rae. ,JUN 5 2009
Filirg Dates: i) Real Property: Must fde during Ne year fo� which the dedudion is sovght.
2) MobDe /Marwlactured Homes not assesseC as Real Property: Must fite dunrg fhe hvelve (12) months before March 310/ each year
fhe deducfion is sought. �� ��
See iaverse side 7or addPional instrudions and qualificafims
tl �nme On iBWd is
r+arre w �r�onpaq� a mnr�a �,
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naarass d �rono�ee «maraa sener
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Ooes a7�1 own PoD�Y in ary alhar
twnty in IMgre7
n Y�
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Mortvage / Cantrad "vde6tedrress urWaid as d
t.iarch i, curtaM year
If ovmed
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No
Recortl number Page number
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�a � coNab �,dec�ea�ess unwd az d �: me ecp�m uie sae
app6mtion legal a equifa�le ameR
❑ Yes ❑ No
ieona aaher ihan s�ouse. iMicate wiTh whmn
Is tlie W W�RY in Guestiort AnnuaM Assessed
� � a�r � rmn�or auessea _
Dra`��er NO...a�C�.J....
Card \'O. ....ISOS....�...
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viu aeauam bean reGUasted on O�M
I mr ameM yean r� .. r� .
COUNTY AUDfTOR
DedWian aGC�'ed in Na amaml of:
20 0 20 20 20 20 20 20
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Signalura d Coumy AWitar Caunly D�a (�. �Y• !'��
I/ We cerlify urder fhe penalty of pujury tha� �he above antl fortgoing ulformation is true a� carteQ and that Me appfirant is a resident af Intliana and
owner! mntrad buyer of the aforementioned property on date applkatbn is filed.
Signafyre (own�YS fiAlwne) Date (mm�M. daY•Y��)
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Fu6 rasident ' s a�f a� rxant n abcet. �abfo. mE LP )
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� Pe�son auNor¢ed by dWy eiBwbd Power dNbmay or by IC 6-1.7-12-0.7 Date (maRh, day, year)
PddresaofaWhorizedpersm (nun6olanOSLOaf,tity,sbfe,andLPoode)