HomeMy WebLinkAboutMortgage_Wilkerson (6)^•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ns ' ar
__ .• FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (Rit / 609)
�' ,.,. � Presai0ed by Department of Local Govemment Finance
�srRUCno,vs: �� Z���
�0 6e filed in erson or b mail with !he Coun Aud'ROr or Coun RecoNer o/ fhe coun where the ro Form med with:
a r b N �Y a aem is �ocared.
Fili,g Dates: 7) Real Property Must file dunng (he year for which the deduction is sought. C� �p i�pr
2) Mobde /Manufactured Homes irot assessed as Real Property Must file dunng the tweNe (72) monNs n
before March 31 oleach yearNe deduction is saeght. L�I �+iVYA , ft
t;
See reverse side /or additionel instruUions and qualifications.
AppGrant (owner or oontrao buyer - see resvcnoqff m reverse siYe)
G�g N OU
TaAng �is � Key nurtiGeANegal descnpfion U Reco�d numher Page numMr
l.� �-, -� �l`�q- o ll ��D
As�sseC vahie d real poperty as d Mortgage / Contraa'ude6tedness unPaid as of Mortgage / Can�act'vitleMed�s.s unGaid as d Is Ihe aPP�t tl�e sde
MarU 7, arrem year Martli 1, n�rtenl year Oate of appficalion legal or eQUkable owneR
[x"�� Yes ❑ No
Ii ro. what ¢ his / her euct share of interest? If awrred wiN mmenn ather Ihan spouse. iMi�ate with wt�ttn
If nama m mmE is drtfuent Nan Nat ot applirant, mdica[e bebw: �5 the m ueSUOn: Mnu
�P?rtY� 7 �'PS�suM
- — -- �aertv ❑ ua�Nn�essee
n�oa�e r�rome pc 6�.�-�
Name of mortgagea or mntraU seller ���, (.
�cQ.eo.����,� Dra��er\0..� � ........
a oNer owner ar
Aearess oi assignee (number
Dces applit2m ovm property in anY oNer
wunry in Intliana?
❑ Yes
�ri and shee4 �+�Y. s�
mortgage
slafe, antl ZIP code)
c�,�a �o. ..
If yes, whal munty?
5 d.� �.......
tor w�*ent yeaR
m propMy
COUNTYAUDROR
DeEucum apyrnW in �he amount of:
20 20 20 20 20 20 20
syrewre a cau,b a,a�rtw Caunry Date (monm. daY. l'��
I/ We certify under the penalry of perjury that the above and foregoing in(ortnation is We and cortect arW Nat ihe applirant is a resident of IrWiana antl
owner I contract buyer of ihe aforemenboned pmperty on date appliration is filed.
s�y� co�+e.s n,n 1 oa� �r�rn. ear. raan
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F A " eN a0tlres5 of appGrant (rwmEer and sbee( tlty. state. and ZIP wde)
� �a, � 5 T ti l�
Person aufMrizetl by dury esewtetl Po�cr a( AvorneY a �Y IC 67.1-12-0.7 Oate (rtpnN, day, yea�
Pddress of authar¢ed person (number a�M slree4 �ry. state. an0 ZIP cade)