HomeMy WebLinkAboutMortgage_Wilkerson (7)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'• �w� ♦ State Fortn 43709 (RS / 4-03)
� PresaiDed Cy Department of Loral Govemment Finance
INSTRUCTIONS: !3'—� �{ — � -File M'1ark
To be filed in person or by mail with the County Auditor o) the county where the property is located. �9 � G—� C' ,)
Filing Oates: 1) Real Property: Dunng the 12 months be(ore May 11 of the year the deduciion isto be eflectiv'e.) �—� 1L6'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year the deduction is to be elfective.
See reverse side for additional instructions and qualifications. U � � 19 2004
Applicant (ownerorcontracf
Assessed value ofrez
March 1, wrreM year
on
Key number / Iegal
� �
as of Morigage
March 1, �
If no, what is his / her exact share of
If name on record is different than that of applicant,
�ne of moAgagee or contract seller �
Address of morigagee or contrad seller (number an
Record numbeyl �/
(J V
� o U f\ � O Page number �6� ��
� l lJ ` l
intrad indebtedness unpaid as of Is the applipnt the sole legal�or equitabfe
:nt year owneR ❑ Yes ❑ No
q00
If owned with someone other than spouse, indicate with whom.
�elow: Is the property in question:
❑ Real Property ❑ Mobile Home QC 6-1.1-n
city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�f, city, ate,�dlR�^�'-'
Does applicant own property in anv �`"
county in Indiana? �I �- � • ~
20
Signature
What Taxing Distrid? Has this dedudion been requested on
property for wrrent year? Q Yes ❑ No
;�UNTY AUDITOR
approved in fhe amount of:
_ 20 0 20 �� 20 �
P � �
County Auditor
20 20 20
: �
; _
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
fent of Indiana and owner of the aforementioned property on March 1, 20
ue (o�ers full name)�'�- Person authorized by duty executed Power of Attomey
'�' Y�+l/1! ri it/rN17 or by IC 6-1.1-12-.07
t address of appliqnt � . ��
G,�. SDb�J S I � �.
Address of authorized person