HomeMy WebLinkAboutMortgage_Wheeler� .
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o� ns p Year
,--
; FOR DEDUCTION PROM ASSESSED VALUATION
Sfate Fwm 93709 (R7T / 6-09)
�' � Presaibe0 M DePart�nt of Local Govemrtrent Firence
L e
wsraucnoNS:
F«m mm wnn:
To be fiied in person or by maii vnth the CounryAuditor or Counry Recorde� of Ne county wFiere the pmperty is located�j
FiI'mg Dates: 1J Real Pmperty: Must fiIe dunrg fhe yrear for which fhe deduction is soughL p' �� ��ounry Auditor
2) Mo6ile / ManWactwed Homes not assessed as Real Property: Must file dunng the fweNe (72) monfhs �u��T�Y
6e(ore March 37 of each year the deduction rs sought. GIBSON C UN� A�uaur�ryRecorder
See revarse side foradditionel insWctior6s and ou3lificafbns. � \
eC vahle af real P�Y as o1
1. ar'art )rar
numCer/�galdesaiption '
Mortgage / Contraa'udebte0nrss i
Martfi 1. WrtEPt]L�� /
II m, what's his / her eraG share ol interestt
tt'urtie m remrd'e 61fu�t Wn Nat of app0�an; hM'u
Name ot mortgagea u mntrad uller (�j �/4
/N
P.ddress oi matgagee or mntrad sWer (number and s0
Name a1 assignee w othrl awner w holder M rtiortgage
Mtlress ot assignee (number antl stree4 �rtl; slate, ar�d
Oces app(�nt ovm property in a(ry oNer
munry in Intlana?
❑ Yes ❑ No
Oetluc6an aowoved in Ihe amount oF.
20 I 20
ciry, atate, ard LP mde)
c
20 20
samearre
num0el
Medness unpaid as of Is Ihe epp�rcant Ne sole
legal a eWitable wme(.+
❑ Yes ❑ No
spouse, iMicate wiN whom
iM property in 7ueslion: MnuaDY Asses5e0
]�a� PmPenY ❑ lvmualiy Asse55ed
Di•a«�er NO. �.9 :. �.3.jS
CaCd i\`O . .............. ...
Counry
20 � 20
dey, y�r)
� v�
20 _
I/ We certry under the penalty of perjury that the above arW foregoing infortnation is We and corterl a� Nat Ne applirdnt is a resident of IMiana and
owner I mnVacl buyer of Ne aforemenlioned proDerty on date application is filed.
7^a�e (awrreYs !utl rersre) _ ' ' (� Date (monfi, daY. Y��
rity, state, and ZIP mtle)
Peison auttnt¢ed Oy tluy esecuted Power of AttomeY a M IC 61.1-12-0.7 I�(�+�h. �Y
Pddress ot auNOr'vEd per:nn (number a�M sbeet, tity, stdte, aM ZIP code) .