HomeMy WebLinkAboutMortgage_Wilkerson (9)^•n
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'� FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�• / Stata Form d3709 (R5/4-03)
w
PrascnDed by �epartment of Loral Govemment Finance
INSTRUCTIONS: - MAY 9 2�ff5Ma`�`
To be /iled in person or by mail with the CountyAUditor of the county where the property is locafed. .
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduciion is to be effective.
2) Mobile Homes assessed underlC 6-1J-7: Between January 15 and March 2 of the y��cj��n is to be effective.
See reverse side (or additional instnictions and qualifications. �igSON COUN7Y AUDITOR
Applicant (owner
see
side)
Key number / legal description � Record number
�/Q � /'f0 rj% `3� �O� Page number
/ / I/ O
Ass s e va ue of real property as of Morlgage / Contrect indebtedness unpaid as ot Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ �o
D 99.�
I( no, what is his / her exacl share of inieresl? If owned with someone other than spouse, indicate with whom.
If name on record is different than Ihat ot applicant, indicate below: � Is the property in question:
mortgagee or contract seller
Address of mortgagee or contrad seiler (number and street, city,
Name of assignee or other owner or holder of mortgage
Address
Does applicant ov. �
county in Indiana � �
approv
20
(numberand st2ef, city, state, ZIP code)
�
-'-- — -°�•��+ha�.i ifyes..what county?
Drawer NO..QS.-,� �'(S'
Card NO . .............
1
What Taxing District?
AUDITOR
20 �_ 20 '� � 20
P �
County Auditor
O Real Property ❑ Mobile Home (IC 61.
Has this deduction been requested on
property for current year? � Yes ❑ No
�
Date
20
�/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that Ihe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
(ull
resident address of
70
Person authorized by duly executed Power of Attorney
or by IC 6-7.1-12-.07
of authorized person