HomeMy WebLinkAboutMortgage_Wilkerson (15)�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�� ✓' State Form 43709 (RS I 4�3j
� PresriiDed hy Department of Lofal Govemmeni Finance
�
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To beRfiled�nOperson or by mail witA the Counry Audito� of the county wheie the property is lo�ted. _� ��jl �
Filing Dates: 1 J Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be elfective. .
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the y�aafth� d�dQ� is to be e(fective.
See reverse side for additional instructions and qualifications.
Applicant (owneror
Taxing Distrid
- see
Assessed value of real property as of
March 1, current year
IT no, what is his / her ezact share of
number / legal description
C� /�-ao ya i-oo
MoRgage / ContraG indebtedness unpaid as
March 1, c�t year
�4Pjn 70007
��a� ��
GIB3p,J COUNTY AUDITOR
Record number ��
Page number �
f Is the applicant the sole tegal or
owneR ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate below:
'ame ot mortgagee or contraIX seller L .
Address ot riiort a ee or contrad seller (number and sf�eet, city, s�
- 9 9------------. .
Name of assignee � " O °- ' � �6� '�
Address of assigri _/�' � e �, ������%/„ ,. ..�J
�.1\/..v� �LO
Does appliwnt rnn Vhat Taxing District?
wunty in Indiana'
C/itt �
/^`/L� l�° .UDITOR
Deduclion approv � 7 7 9� ��
�
Signature
County Auditar
zo
� the property in question:
❑ Real Property ❑ Modle Home QC 61.1-�
Has this deduction been�requested on
property for current year?0 Yes❑ No
�
Date
2� -
'/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�a resident of Indiana and owner of the aforementioned property on March 1, 20
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
3ppticant -— Address of authorized person
S. �n ie n--� rA C�