HomeMy WebLinkAboutMortgage_Wilkerson (9)"'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBiEDNESS Coun 7ovmship Year �
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: FOR DEDUCTION FROM ASSESSED VALUATION
n Sbte Fo(m <3709IR71 / 609)
,,�,� 1 PresmhW q DeP�M ol lnrel GovemmeM Fi�rce
INSTRUCTIONS:
To 6e filed in rson w b ma�l with the Coun Auditw or Coun Recorder o! fhe coun whe�e the ro FOf�° ��1 �'
ae r ty h �r v cenr�ro���AN
Fi7irg Da[es: 1) Real Properfy. Must file during the year (or which the deducfion is soughG � 13 ����, q��
2J Mob�7e / Manufactured Homes rrot assesced as Real Property Must Re during fhe hveNe (12) months
betore March 31 of each year the deducfion is soughG ❑ Coun Recorder
Sea reversa side for additional inslnxGons arM quelifications.
�AOO�P�immeroroonLaC6uyer'se4'��+�mRversesifeyi �
Ta�1drg Distri�i{��, ` J� /t {(ey �
�A � .'I ✓ '^'� �'"
Asessed radre d real p(apeny es d
M1faidi 1, amPn� year
�,�,,,�,��,����a��
It n2me m remrtl is drtlerent Nan Nat ot appl
—,X _
6idirata hebw:
Remrtl number Page wmber
y ouy_oDD.�B�r- o �.� aora aa �?
dehtedness unpaid as of Mwigage / Con;rart i�dehtedrress �mpaid as of 4s Ne app6�nt fhe soie
date of appGptmn kgal w equita6le oxivll
4 � � 0 0 ❑ Yes ❑ No
H owned with someore aher Ihan sPCUSe. kdkate with whom
Is the perty in quesGOn: AnnuaM Asessed
Real PfoPenY ❑ Mnuall�' a"sessed
Name of morigagea or mntract seller /` /�
S
Add2ss of mort9a9ee ar mntrad sellet (nwn r and straef, city, state, aM:
Name of assignee w oNer ovmer or holder of mortgage
Address ot assignee (numbera�W streef, ciry, sfafe, erM LP code)
Dces epplimnl o+m property in any oNU I( yes. what munt�?
counry m Inda`a?
❑ Yes ❑ No
Dr�ucOOn approved 4i ihe amwnt ot.
20
SigfanneW bnwttor
I I We cert'rfy under the
ownerlcontractbuyer
� Sig avmeYShdnertre;
, uB' 'deni address W app0
�
DI a11'�Y 1�i�...�V' �
WhatTa�dn •••••....... �
c�,-� ���o. . �ay � No
a�oRar � yc�,�pi p_ �.... _
20 _ 20 _ 20 20 _ 20 _ 20 _
• ��N Data (nmth� daY. Yea�
�J
enatty of perjury that the above ard foregoing infomia6on is we and cortect and that Me appiirant is a resident of Indiana and
F the aforementioneG pmperty on date appfintion is filed.
Pe�son auUwr¢e0 6y Euy exew•s0 Po�Mer W Attort�ey w by IC E7.1-12-0.7
Pddress of auNOrrzeO person (numberarM stree; firy, uate, entl LP code)