HomeMy WebLinkAboutMortgage_Wilkerson (10)��
� � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
a w� J State Fartn 43709 (R6l 5�06)
� Presaibed by Department of Loml Gwemment Finance
INSTRUCTIONS:
Coun Township Year
I E I)
MAY 0 ��i��7�
To be �led in person or by mail with fhe Counfy Audito� of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6efore June Il o/ fhe year the deduction is to be eff yf4ye, ��
2) Mobi/e Homes assessed under IC 6-7. 7-7: Between January 15 and Ma�ch 2 of the year the �ucho s to be elfective.
GBSON COUNTY AUDI70R
See reverse side !or additional instructions and qualifications.
Applicant (ow e�orcont2ct buy - see restrictio on 2verse 'de/� �C/
S
Taxing District Key number / legal descriptlon Record number � �
�-�a�0� b4-003•a�•0 Q,
� / �1 � n�'� � age number � � �
3'
Assessed value oi real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year owner? [�'es � No
�
y t�ooa
If no, what is his / her exact share of interest? ; If owned with someone other than spouse, indicate with whom.
If name on record is different than that oi applicant, indicate below: Is the property in question:
❑ Real Property � Mobile Home QC fr1.1-7)
ne of mortgagee nVacf seller �
� C�
Address of mortgagee or contract s iler (number and street, cify, sfate, ZIP
p°-�''�D �aZO.S�L
Name of assignee or other owner or holder oT mortgage
Address of assignee (number and street, crty, sfate, ZIP code)
Does applicant own property in any other Ii yes, what county? What Taxing District? Has fhis deduction been requested on
wunty in Indiana? propeAy for current year? Q YesO No
COUNTY AUDITOR
Deduction approved in the amount oi:
20 20 o zo zo zo 20 20
�
Signature County Auditor Date
I I We certify under the penalty of perjury that the above and foregoing information is W e and cortect and that the applicants was 1 were
�sident of Indiana and owner of the aforementioned property on March 1, 20
ure (owne/s (ull name) Person authorized by duly executed Power oi Attomey
r' or by IC 6-1.1-12-.07
Full resid t address oi applicant X`7(P 7 Address of authorized person
� '_ `�C � , \ `
/�L J