HomeMy WebLinkAboutMortgage_Wilkersona�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Cs�� FOR DEDUCTION FROM ASSESSED VALUATION nt ship Year
'•. ! State Form 43709 (R6 / SO6)
�.
Presaibed by Department of Loral Gwemment Finaxe
2��6
INSTRUCTIONS: File Mark
To be fi/ed in person or by mail with the County Auditor ol the county whe2 the p�operty is locate�
Filing Dates: 1) Real P�operty: Dunng the 12 months 6e%�e June 11 of the year the deduction is td be e�ct��
2J Mobile Homes assessed under IC 6-1JJ: Between January 15 and March EtB$f��Edd�tledlrtltbip(s to be effective.
See reverse srde fo� addrtional instnictions and qualifications.
ApplicapT]o er or cont ct buyer see restri ' ns on reverse side)
C'
Taxing Distrid Key number / legal description Record number
� b -/d -07-�/0}�- Do/. 33S'o � 8 �
�/ _ � Page number O /�
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is lhe applican tt he.,sole legal or equitable
March 1, current year March 1, current year owner? ��es ❑ No
�_�
�l �
If no, what is his / her exact share of interest? I( owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
Property ❑ Mobile Home QC 61.1-�
me of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, ciry, state, ZIP code) �
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduclion been requested on
counry in Indiana? property for current yea(? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 �� 20 � 20 20 20 20
\ 1 �
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
. a resident of Indiana and owner of the aforementioned property on Marrh 1, 20
Si alure (owners Iull name) Person authorized by duly execuled Power of Attomey
�/ J .�.'��' or by IC 6-1.1-12-.07
G..2c' �-�._
Full resident address of applicant ' Address ot authorized person
2 v i1�`:i�r-�s — �%