HomeMy WebLinkAboutMortgage_Wilkerson (8)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ __ FOR DEDUCTION FROM ASSESSED VALUATION
�� State Fortn C37091R71 / 6-09) .
♦ � P�esaiGetl by Deparlme�LL of Local GovemmeM Fi�nce
� 1�
�STRUCT(ONS: Fam med wrth:
To 6e filed in person a by mail with the CountyAuditor or Counry Recorder o/ the counry where the pioperty is located. � q. ���'�
Filing Dates: i) Real Pmperty: Must file dunrg the year for whicfi the deduc0on is sought. O �� ditor
2J Mo6de / Manulactumd Homes rat assessed as Real Property: Must fiie dunng fhe twelve (12) montAs
before March 37 0/ each year the deduction is sqght C.' � Recordu
See reverse side for addifionel inshuclions aM qualifications.
If no,
�r:�
:e0 vdue af real P�W�Y �
1, �i�mt �
m remN a difierent ihan ihat of aPP�� uMicate 6eb�r.
Name ai mortgagee m mntraG se�er �
Addres of mornJa9ee a cantracl se�er (num
Name of assignee w other awner or hdder of
Address i0 2�9�� (nurtiher ard street �:
Ind'ena?
Yes
Deduction aPYoved in Ihe
Retad number Page �wmori
3 . oa -000. y�3 -oa� �v
'uMehteEness unpaiA az af Mortgage / Contract indebtedness unpaid az M Is Ihe appficant Ne sde
r Aale of apptiration �egal w equitade owrre(+
O ❑ Yes ❑ No
Ii mied with sortieane ott�er Ihan spouse. iMipte with whom
Is the property in Questia�: M�waOylASesseE
� Real RoPenY ❑ !�^!�Y � . . .
�v and sfree4 �dY. �te. aM ZIP code)
mortgage
sfate. an0 Z/P ootle) �, O�/ ��/
�t yes. wnat crn,ny.� wnat rabry oao
I No
COUNTYAUDROR
2p 20 I 20 _
sig�aane w b nwitor
�- T
I I We certify under Ne penalry oi perju at Ne above z
owner / mntracl buyer of the afo2mentioned property wi
FWI s
G
Pcnm
^J
n�vEE by Euly exeCUtetl Power of Attomey or Oy IC G7.1-12-0.�
aufhoraea person (numberand snee4 ary, stale. and ZIP wde)
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—� 0 N FJ (.c��.ICE�.SU,cJ -
/I-y7�� -
C
20 20 _ 20 _ 20
Counry Date (rtnNh. EaY Y��
�g information is We and cortea and ihat Ne applipnt is a resident of IfWiana and
ation is filetl.
Date (morvh. tlaY• Y��)
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