HomeMy WebLinkAboutMortgage_Wagner (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
= s FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (Rti /609)
�' ` Presaibed Oy DePartment oT Lxal Govemmenl France
iI a
WSTRUCTIONS:
To 6e filed in person w by mail with fhe CounryAUditw or Counry Recorder o! the counry whe2 fhe property is located. F(�� ��1��
Filirg Dafes: 7) Real Property: Must file during the }rear /or which the deduction is soughL J� 1�u� �ditor
2) Mo6de /Manufactured Homes rrot assessed as Real Property: Must file d�tirg the tweNe (12) rtwnfhs
6eforn March 37 0! each year the deduction is sought. C_ Recorder
See reverse side to� additronal instroc6ons arM qual�cafions
Appfaan�(owner mrwart6uyzr-see�trict?nsaJrewrge§ide) �. , � SON COUNTV Al11llTfia
A�sseC wWue o( real proprlty as d Mor(qage/ Contrafl'uWeOteEness unpaid az o( Mortqage / Con� uWebteErress unpaid as d Is Ne applkant Ihe sde
Ma�C� 1. anart year Ma�di 1, a date of appGption legal w epuitade ovmM
❑ Yes ❑ No
m. what is his ! her entl share o( interesE? It awned xith someo� dher �han spouse. indinte wtth H1nm
If name m remtl "s diRuent Nan ihai ol aP ��-'"'- --- -� - . Is the property in Question: Mnualty Assesse0
❑ Rea� Property Q amua�ywssessed
W A 6 d EK� G�oP.c�e; R �,� � �� �,.,-;
Name of mort9agre a rontract se0e� ��
_ '"'! S
Address al martgagee u contraM seller (ni / I
—�/� /
Name of assgnea w other awner w halde�
Does applimnt wm pmpnrty in any ottrer I If yes. what wuntyl I LMiat Ta�drg D"¢tritl? I Has this deductirn been requeste0 m p�opMy
munry m InCiana? ❑ Yes ❑ No for artent yeaR �
❑ Yrs
GOUNTYAUDROR
Detluction appiove0 In ihe amount oE .
20 _ 20 _ 20 20 20 _ 20 20 _
SigriaLUe of Camry NAttw Caunry Date (monih. daY, Y��
I/ We certify under Ne penalry ot perjury that Ne above arW foregoing intwmalion is We and mrtect arW that the applinnl is a resident of India� arM
owner I contrad buyer of the aforementioned property on date applicalion is filed.
Si vmer's hfi name) Data (monrh. day, YeaA
I ' ent aEdrrss nnt (nu O� late, aM LP aotle) � ��
\
Person autl�o(¢ed by duty exewted Pwer of Attomey or q IC G7.1-12-0.7 Oate (rsronlh, dey, yEa� _ _
AEdress ot aWromed person (number arM sbee; dry, srate, an0 LP cnde) .