HomeMy WebLinkAboutMortgage_Wilkas"`�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
�r_ • FOR DEDUCTION FROM ASSESSED VALUATION
n Slate Folm 43709 (R77 / 609)
,' l Presaibetl by DePa�N of Local Govemment Frunce
wr
INSTRUCTIONS:
b be fifed in person or by maii with the CountyAuditor or Counry Recwde� of the county where the property is bcated.
Filing Dates: 7J Real PropeRy Must file during Ne year /or which the deduction is sought
2) Mo6i7e / ManulacNred Homes rrot assessed as Real Property: Must fife dunng the fweNe (72) months
before Ma�ch 31 0l each year the deduclion is saght.
See reverse side la additional instructixu and qual�cations.
AppSCant (owneyEFyontracf buyer�ee rest�ir�tb7s m ByeRe side)
x real p'opary as m
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Fmn A3Witl!—J �J �L
C��/{ntJy A�u�dit�o�r
CoIIntt f7�'Cd7er
GIBSON
v wcn • J w/ V / Q[ J
/ CantraG intle6tednrss unpal0 as ot Mortgage / Contraci iMebtedness unpaid as of 4s Ne epp0ont fhe wk
nt data of apPfifation legal w equitade oxne(.�
❑ Yes ❑ No
tf owned wiM someone other than spwse, IrMkate wiN whom
telow: Is Me properiy in Gue56on: MnueOy Asse55ed
❑ Real ProPeKY ❑ ��Y ��
Narre ol nKUlgagee u tontratt 5e4er 0 N B
Adtlrea of mortgagee u cantract seAer (num6er and streel, cdy, sla�, ard LP oode)
Name ol ass4p�ee w oNU oxner m holdu of mortgage
AEd2ss ol assignee (number antl slree4 �N: sb@. anC LP cotle) '__
uoes appi�nt own praperry �n any oNer
munry in Irqiana?
❑ Yes ❑ N
4� Me amounl oF.
wT�K(�S, �C S
I�- d �3�
Fias Na Oetluflm DG¢n 20UESl¢0 On pTpPlty
far wnent W,aR r-� .. r-� .
20 _ 20 _ 20 20
Signature ot CAimty AuditOr Counb De�e (rtpnth. deY. Me�
I I We certify untler the penalry W perjury that the above aM toregoing informalirn is We and cortect aM that the appii�ant is a resident of Iridiana afW
owner (.c�ntraU buyer o�(ha �raemerttioned pmperty on date applicatlon is filed. �
AEtlress of aut�a¢etl person (number
ary, seare,
m�
; state, ar,
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