HomeMy WebLinkAboutMortgage_Wilkerson (13)'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ FOR DEDUCTION FROM ASSESSED VALUATION
�• St2ta Fortn 43709 (R71 / 6-09)
�' ,�,� f PresviEetl by �epartmenl of Local GovemrtreM Fuance � �
INSTRUCTIONS: � \�Q
To be filed in person or 6y mad wiN the CountyAUditw or Counry Remrder of the counry whe2 the poperty is located.
Frtirg Dafes: 7J Real Properry: Must fi!e during the year fir whirh fhe deduclion is sought.
2) Mo6de / ManulaGured Homes not assessed as Real Property Mus! fi!e dunig the twelve (12) months
6efore March 37 0/ eadr year the deduction is saqht.
See reverse side (or addifionel instructions and qualifications.
MP�nt ar conlraC bu1Ti1 ��i��iT 9P �versa siAe) .
I rahle U real
a.mJrt year
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Name ot nnrtgagee or mntrxt se4u
Mdrea of rtartga9ee a contrad srder (nunbcv er
Name of assignee w otlrer ownet or hdder af mort�
Ad42a ot atsig�ree (number ard street �l: slate.
Ooes eppli�n[ wm poperty in any aher
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� kgal aesvipn^on
�� �N�
triGkate Gebw
riry. smm, eM LP code)
If yes. what munlyl
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az U MorU3age / COntrart
date af applimtion
What Tad(p7 District7
File
�� I 1� . ..•.
1,
Recard rwmOc I Pa9e numbet
I legal or epultade amel.+
❑ Yes ❑ No
sv�e. md�te wfih wirorn
Is ttie property in pu�tion: MnuaOy A55Eised
❑ Real Propeity ❑ lvmually Assessed
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u(rern Y�� r-� .. r-i
COUNTYAUDROR
DeducOOn apywed in tlre amounl of.
20 _ 20 _ 20 20 20 _ 20 _ 20 _
Si9tu4rte d Camry Auditor Counry Da�e (monfh. CaY. Y��)
I/ We certiy urWer the penatty of perjury that Ne above aM (oregoing infortnation is true and cortect arW that the appircant is a resident of IMiana arM
owner I contrad buyer ot the aforementioned property on date apd��n is filed.
' Wre (oxne(s hN rertre) Date (monfi. daY. Yaa�
F � ent adtlrnss of appfzant (numDer and s1reeL ary, s+ate LP ootle)
Person autha¢eE by dWy exeated Porer dAtlomay w q' IC 61.7-12-0.7 ' �(�N. �Y• Y��
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Address of auNa'ved persm (numDer arM stree4 �+b. s+a�e. antl ZIP cade) . �