HomeMy WebLinkAboutMortgage_Wilkerson (14)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` �w ! Stata Fwm 43709 (R514-03)
• Presaibed by Department ol Loral Govemment Finance �
INSTRUCTIONS: ---���((( � ile aric
To 6e filed in person or by mail with the County Auditor of the counry whe�e the property loo at�d.�
Filing Dates: 1 J Real Property: During the 12 months be(ore May 11 0! the year the dedu is�Y b e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma oI the year t�e dap4ation is to be effective.
See reverse side for addifinnal insfruc�i�ns and aualifir.afinns.
SEP 3 Luu.+
Applicant vner or confract bu - see stricfans on reverse side) COUN �'•' �'�����R
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Tauing Dislriq" / Key number / legal descriplion Record number
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d� Page number
Assessed value of real properry as of Mortgage / Contrad in�btedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, curcent year March 1, current year � q� O O owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? f owned with someone other than spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie QC &1.1-�
�"ame of mortgagee or contreIX seiler
Address of mortgagee or contracl seller (number and street, city, state, ZIP �
Name of assignee or olher owner or holder of mortgage
Address of as"signee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduclion been requested on
county in Indiana? property for current yeaR � Yes� No
COUNTY AUDITOR
Deduclion approved in the amounf of:
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• � �
Signature County Auditor Dale
�/ We certify under the penally of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur (owners full name) Person authorized by duly ezeculed Power of Attomey
„,/ C��%�n, __, or by IC 6-1.1-12-.07
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Full reside address of ap cant Address of aulhorized person
S i s, s�m; � sr.