HomeMy WebLinkAboutMortgage_Wheeler (2)i�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i� • FOR DEDUCTION FROM ASSESSED VALUATION Year
�' _«. ! Stale Fam 43709 (RB I S-06) �\b�
� Presaibed by DepertmeM of Laal Govemmenl Finance
INSTRUCTIONS: File Mark
To be /iled rn person or by mail with fhe County Auditor of the county where the propeRy is located. � ,Q�
Filing Dates: 1) Rea/ Property: Dunng the 12 months before ,lune I f of the year lhe deduction is to be efl�¢c i A c]
2) Mobile Nomes assessed under IC 6-1.1-7: Between January 15 and March 2 of fF���2�%'ih�9 �c�i6 �i��to-! e effective.
See �everse side lor'addilional instrtictlons and qualifications.
Applicartt eraconhact 6�er- see restnctions on reverse side)
(�lJ
Tauing Di rid Key number / legal description Record number D�
/
o� ��'�.36-o2�-�Q3.706-D�/ Page number � �' �
Assessed v d reat pro as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt lhe sole legal or equitable
March 7, amed year March i, curtent year ownert ❑ Yes ❑ No
$�, oo� �: .
I( no, what is hi6/ hw e�tacl share ot interest? If owned with someone other than spouse, indicate with whom.
If name on record fs dftereM than that of applicant, indicate below: Is the properfy in question:
— ❑ Real Property ❑ Mobile Home (IC 61.1-�
'' e of mortgepee oreonVaq seller � DCa1ti'er \T Q �
� S�-v�-� �,�'�c.��.2e�J � O. ....%. -. . �.-? / �
Ad ss of moAgagee cr conVacl seller (number and street, city, state,
Card NO . ................
Name of esapnee a,dher owner or holder of mortgage �����
Address ol as6ignee (number and st2et, city, state, ZIP code)
Does appficmM own prppeAy in any other If yea, what county? What Taxing Dislrid7 Has this deduction been requested on
county in Indans9 property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20�_ Z0�_ 20 20 20 20 20
�
Signature Counry Auditor Date
We certify undet tha panalty of pery'ury that the above and foregoing information is true and correcf and that the applicants was / were
sident of IrMiana and awner of the aforementioned property on March 1, 20
Signature (owner's /ull n� �� Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull re ent 8ddress ol8pplicant Address of authorized person
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