HomeMy WebLinkAboutMortgage_Wilkas (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:�-. -.
• FOR DEDUCTION FROM ASSESSED VALUATION
•�•' f".^ State Form 43709(R11/6-09)
‘tit:'T:6,41; Presaibed by Department of Local Government Finance r' 7�®�n�J�
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�NSTRUCT/ONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is I t
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not agcncced as Real Properly:Must file during the twelve(12)montlw E6 4- 3 County Recorder
before March 31 of each year the deduction is sought. r
See reverse side for additional instructions and qualifications. �
Appfica• of contract boyar-see .:.rs• _ - - II�'Tlr raring:
0_v,�. �: .A 41.4 . . • TY AUDITOR
T. 'y: rrsoict 4 Key / desaiptbn Record nom P e inter
CQ .. - �' w�i-000. 4fsa oaI �3 err
Assessed vaitte of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,and year Mardi 1,a year date of appli ation legal ar equitable ownerT
Io, �� ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name an record is di ferent than that of applicant,indicate below'. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
on 6
Address of mortgagee or contract setter(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in any other If yes,what county? Wbat Taxing Disbict? Has this deduction been requested on property
county In Indiana? n
❑ Yes ❑ No for anent year? ❑ Yes ❑ No
A COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
comer I contract buyer of the aforementioned property on date application is filed.
Sig^��(/(owne(s ,riyA-��/y n Date(r_ -day,year)
Full relent ad Tubas t mberrrff a�dry,ststaate and ZIP codee))Gj(�_(J_ _ _
Person( authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 - Date(month,day,year)
Address of authorized person (number and street,city,state,end ZIP code) .