HomeMy WebLinkAboutMortgage_Wilson (6)^'+ STATEMENT OF MORTGAGE OR CON I DE�D E� Coun 7ownsnip vear �
_ • FOR DEDUCTION FROM ASSESSED V�1L ��
• State Fwm 437W (R71 / 6-W)
S,,,. ��,����aa,�,���F� pEC_ 0 3 2012
INSTRUCTIONS:
To be fi/ed in person or by ma� witli the CountyAUdiror orCounry Recorder of ��unry roperry is located.
FiTirg Dates: 1) Real PropeRy: Must file durirg Ne year /or whidi tha deduction is soughL
2) Mo6�7e / Manufacfured Horrms rrot assessed as Real Plppe,h�-�+�t(y�p�[fitA�� (}2J months
6e(ore March 31 of each year Ne deduction is sayhG �� � t3a
See reverse side foradditional insWCffons and qualifications.
AHP�?_^� (owrrer ormnlraC byy�- see re4nctip+p m reverse siCe) � O . � n
// � Key number / 1e9a1 desaiPdm
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rc �a �c � na � ne� exau sn� or �,�n
It rwne m remd is N.TUent Nan that af appGranl, uWua� bebw.
Name m rtnrtgagea «
Address of martgagea
w omer ownu or ndaer o� mortgage
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az
File Mark
Form filed uith:
� CounryAuditor
❑ Counry Recorder
as
I date o( aPP���^ � kgal or eW itaWe o�ttiM
❑ Yes ❑ No
If wmed wi� someone other ihan spouse. kid)pte with wfwm
Is Ihe praperry in Vurstim: Mnua�y Assrssed
RealPfoPenY ❑?!?�!�a��Y0.,s�sed...
aGaress ot asv9nee (numoar airo sueeG a+y, srare, ano ur cooe) �
�lYl{YC!• i � '/-/�
Does eppinaN own property in any oNer • If yes. wha[ count�t Whal Ta. \ O• .�O/oL � �ny
munry in Indaia? ❑ Ye5 /� � � ' • ••
❑ No l..:ll ❑ No
couNrr nunrt,.. _ /�
��\�� /'`���/
DeDumon aPW�d in ihe nt af: �� �CJ/
7�� '........
2� _ 20 _ 20 _ 2� 2� _ 2(1 _ ZD _
SigfaWre of Coin+bAUditw Counry Date (rsrmth. daY.YEa�
I I We certiy under ihe penalry of perjury that the above arW foregoing information is we and wrrect arW ihat the applicant is a resident of Indiana and
owner / contract buyer of ihe aforementianed pmperty on date appfiration is filed.
�,paai�wnrls h� name). �. _ n , _ Date (monrh. daY. Ya�)
fent address of appGrant (number antl sfree; ti!}; spte, vM LP mtle)
'7 a 3 w�t o o s c� w�e�a,-�.,P
�Ww�'¢ed �y dWy e:ew[e0 Power of AttomeY w by �C G7.1-12-0.7
of authoraed person (numberarid sbeet �pl: sbte, eM LPCOde)