HomeMy WebLinkAboutMortgage_WilkensSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C To s p Year
S / Siate Fortn 43709 (RS / 4-03)
� Prescribed by DepartmaM ot Loral Gfivemmam Finance
INSTRUCTIONS: File M�4t�
To 6e filed in person or 6y mail with the CounryAuditor of the county where the property is located. �a� �G5 A`�
Filin Dates: 1 Real Pro e Durin the 12 months be%re Ma 11 0/ the U
g ) p rty: g y year the deduction is to be effective. �NTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year�l���u��fon �s to 6e eHective.
See reverse side /or additional instiuctions and qualifications.
Applicant (o r contract uyer - s restridions on reverse side)
/ S
Taxing Distrid Key number / legal description Record number �O G��
�(�!��� �// _ �j?� a _ � Page number
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Assessed value oi real property as of Mortgage / Contract indebtedness unpaid as of Is the applican the sole legal or equitabie
March 1, current year March 1, currenl year ownef? ❑ Yes � No
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? q� If owned with someone other lhan spouse, indicate with whom.
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If name on record is dif(erenl ihan thaf of applicanl, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
�me of mortgagee or conlrad seller
Address of mortgagee or contract seller (nu ber and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage �
Address of assignee (numberand st2et, city, state, ZIP code) OQ�: 7 I�
Dra�ver ��� ....
Does applicant own property in any other If yes, what county? W, ,, i requested on
countyinlndiana? CaYd��""...•••••""..• ?�Yes�No
COUNTY AUC
Deduction approved in the amount of:
2o zo �� zo � zo 2o zo zo
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Signature County Auditor Date
�We ceAify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (owners (ull nam Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Fu11 resident address of applican Address of authorized person
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