HomeMy WebLinkAboutMortgage_Wilson (5)"^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ship r
_ s FOR DEDUCTION FROM ASSESSED VALUATION
State Fam C3709 (R71 / 6-09)
�' w. � PresrribeC Ey Departmarrt oi Laml Govemment Fnance
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INSTRUCTIONS:
Fortn Aed with:
To be filed in person or by mail with the CounryAutlitof or Counry RecnNer af fhe oounry where the property is located.
Fifing Dates: i) Real Pmperty: Must fife durirg the year7or which the tleduc6on is sought ,�e���
2J Mo6ile /Manulactured Homes rrot assessed as Real Property Must fiie during the tweNe (72J months
before March 37 o/each year tAe deduction is sought G� $��mlf �0R
See reverse side for addifiWnal instruct�uns M qualifications.
��. MP�n or o94UaU 6uYe�ijee m reve�se sidej .
March 1. curein Year I Mamh 1. a�rtem year
n �o. �ma� �s ms i n� �a � a�rea.aa
rc fwr�e m remrtl's eifterent than Mat of apP�i. 6Mifate bebvr
Name ot rtvutgagee or crno-act seller
Address of mM9a9� w mntraa se�
��.
AOtlress of assignee (numDU antl stree4 ciN. s+afi. entl LP code) •
Dces aQptipnt ovm property in any oNU If yes, what munty?
munty in Indiana?
❑ Yes ❑ No
�'��1���5�7
az
ir
Recnrd numEer
: m a0 /�-/' ( Y LJ I�� a eWinde amer�
❑ Yes ❑ No
�spouse. 4Wicate witti wtan
Is Ihe V�GertY in OuesUOn: MnuaDy AssesseE
❑ Real Pfovertv ❑ ivmuanyASe�� . . _
1..1
�. �o��c��'� o��
WlatTarin9D¢tric. �) 0�0 �
20 I 20
20 � 20
Sig�awe W CawtYAUtlttw I Caunry I Date (nmrn. daY•Y��
I I I We ceNty uMer Ne penalty o( perjury Ihat the above and foregoing intortnalion is We and mrtecl aM that the applirant is a resident of IMiana aM
wmer I contract buyer of the aforementioned property on date applicalion is filed.
Si9 (owne/s !W rmma) Date (rtmM, daY. YaaA
�.�� � � 1�1
FW revtlent � eppfaant umDe a sbee; tiry, e. LP /' ����
�Qr i� r � �2to�
P auNOr¢etl Ey dWy ezewted otAttm�eY w by IC 61.1-12-0.7 � Date (monN. dzy, yEa�
ldtlr� of autlmr'ved person (number and sbee; �ip; state. and ZIP code) .
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