HomeMy WebLinkAboutMortgage_Wilson (7)�" STATEIVIENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township _ Year
S' �� State Form 43709 (R4 / 10-07) \
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� Prescribe0 Dy Department of'_ccal Gcvemment Finance � i; i�1 T �
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INSTRUCTIONS: � U N 3�/ ����
To be filed in person or by mail with the County Auditor ol the county whe2 the prope�ty is located.
Filing Dates: 1 J Real Property: During the 12 months beto2 May 11 0l the year the deduction is t�e el/ective.� � ^
2) Mo6ile Homes assessed under IC 6-1 J-7: Between January 15 and March 31 0/, ¢I%��yce,�a.r, �th�e�_deducn n is to �be yeHective.
See reverse side for additional instructions and quali�cations. r;i/� a.c.nra r'n�iuT e��'nc I
Applicant (o or ontract buyer- ee r@st ' io�ns, /on' 2verse side)
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Taxing Distrid Key number / legal description Record number /�G �
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' Page number
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Assessed value of real prope as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, wrrent year Marcl} J, current year owneR ❑ Yes ❑ No
9 ��
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicant, indicale below: Is ihe properry in question:
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�me of mortgagee or contrad seiler � Drawer NO...
C�r'i o�3 ,r- s�3/ � .......
Address of mortgagee or contract seller (number and street, city, state, ZIP Card NO. .�N�
Name of assignee or other owner or holder of mortgage �'�-.- �/-�-��-��
Address of assignee (number and sbeet, city, state, ZIP code) � ��� �{ / 1
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Dces applipnt own property in any other If yes, what county? at xing District? Has this dedudion been requested on
county in Indiana? property for wrrent yeaR� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �% 20� 20 20 O 7 20� 20 20
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Signature County Auditor Date
�� We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and lhat ihe applicanls was / were
resident oi Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s full name) Person authorized by duly executed Power of Attorney
._.L�-���_ or by IC 6-1.1-12-.07
Full resident ad ess of applipnt Address of authorized person
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