HomeMy WebLinkAboutMortgage_Wilson (2)��
�ei''' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -- -- --• •-
'�n' "' �: FOR DEDUCTION FROM,ASSESSEU.VALUATION •o "t ;' ' ;7own§hip ;� Year
� � x; ... .$..ef'
� Siate Fartn 43709 (R6 / S-06) . ' �''." � � +�=
� P�esaibed by Deparimeni of Laal Govemmen� Finance
INSTRUCTIONS: � �
To be �led in person or by mail with the County Auditor of the county where the p�operty is located. ��NTY�!�R
Filing Dates: 1) Real Property: Dunng the 12 months 6efore ,lune 17 0/ the year the deduction is to4�g�irti�.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0( the year the deduction is to 6e effective.
See reverse side lor additional instructions and quali(ications_
Applicant
Tauing
�
see
Assessed value ot real property as of
March 1, curtent year
Ii no, what is his / her exact share of interest?
side)
/ d v /L/
Key number / legal des tion Record number
�� /�G � ° 3 Q° �/ Page number D
d�
Mortgage / Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, current year owne(? ❑ Yes ❑ No `-
O�
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate betow:
�me of mortgagee or contrad seller
Address of moAgagee or contrad seller (number and street, ci ,
Name of assignee or other owner or holder of mortgage
A� _ ' _ ' ' - ---' -•--` _:... �.�m �IP code)
�50� � �� A,JC ES M
a �/�ri/2L�S' �'
a�1--�io�
approved in the amounf of:
20�_ 20 O q
� %
Signature
tcounry?
ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
❑ Real Property ❑ Mobile Hmre (IC 61.1-�
Has this dedudion been requested on
property for wrrent yeaR � Yes ❑ No
20
20
We certify under the penalry of perjury that the above and foregoing information is true and correcl and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name)
Person authorized by duly executed Power oi Atlomey
or by IC 6-1.1-12-.07
ent address of a plicant Address of authonzed person
� � S. �� _