HomeMy WebLinkAboutMortgage_Wildt (3)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 63709 (R11 / 609)
•� ,�,. � PmsaiEed by Departrtiertl af Loml GovemrtreM Firence
File Mark
INSTRUCTIONS: '1
To 6e lled in person oi by mail with the CountyAuditor or Counry Recorder o/ the county where the pmperty is located. m F .
Fifirg Dates: 1) Real Property: Must file durirg the year /or which the deducUon is sought. nty Auditor
2) Mo6Be /Manufactured Homes not assessed as Real Property Must fiie dunng Me tweHe (72) months C'
be(ore March 37 0/ each year the deduction is saght. � ry Recorder
See reversa side 7a addifional insWCfions and qualfications. ��N
AppG4am (owy�r oroontraa buye� see�e9n'rtiuQs m r�verse side) . , . _ �
/� ' U ' (i(lV �
Asseaed ralue �d mal piopeny az d ' Mortgage/ Contraa "uMeetednass unpaid az or
Ma�di 1. wRnt Y� Marfh 1. artent year
ir ro, w�at is his I Iwi exact share oi intrlest? It owm
If narre on recprp is tlifierent ihan Nat of applMant, irMinte belovr.
Name ot rtnrtg2gee or mnVar� se�er �
Addfess o1 rtnrtgagee W tontraa 5eller (number am1
Name ol assynee or oUer wmer w halder of mort9a�e
Address of assignee (numher arM sbee4 ciry. state, and
Dces applipnt wm prapnty in any other
munty m Ind"ana?
❑ Yes
No
tiry, state, aM ZlP code)
If yes. what muntyt
az
kgal a equitade owne(/
❑ Yes ❑ No
wich somew�e other Ihan sPOUSe. md�te wiTh wlwm
Is Ihe property in puestion: Mnualty Asxssed
� Real ProPertY ❑ ?!?�!!a��Y ��
Deen reGUnstetl m property
COUNTYAUDROR
Deductlan apprweC in the amount af.
20 20 _ 20 20 _ 20 _ 20 _ 20
Si9raLae N Camry Audi�ar Caunry Dam (nrmth. tlaY. Y��)
1/ We certify under the penalty of perjury that the above and (oregoing intortnalion is We and cortect arW that Ne appiipnt is a resident o( Indiana arM
owner I contrad buyer of ihe atoremeMioned pmperty on date appiication is fi�ed.
Sig�Wre (owner's hN rertre) Date (rtmlh. daY. Y�e�
FW residerrt aEtlress of appGnnt (number antl sfieet, til}; state, and ZIP oode) � _.
Person autlqi¢ed by Ouly exewied Power ol MioeneY w by IC 67.1-72-0.7 Date (monN. Gay, yge� _
AOtlreSS of authoivEd person (numbe�aM Sfree[ city, SfdfB, an0 LP Cotle) .
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