HomeMy WebLinkAboutMortgage_Wilhite STATEMENT OF MORTGAGE OR CONTRA TED(E}HS� County Township Year
pGIE ' FOR DEDUCTION FROM ASSESSED VALU Ott �1�1LLJJ���
State Form 43709(R11/6-09)
Prescnbed by Department of Local Government Finance
SEP 1 8 2013 File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the oou 3? ere t yj-fly is located. FormtttG,,,���_A,e,d��-�wiN:
Filing Dates: 1) Real Property Must file during the year for which the deduction is .r,,��+IRllit+r County Auditor
2)Mobile/Manufactured Homes not assessed as Real PropertYlM '+'@•9- " . :yw I3Q€nlhs
before March 31 of each year the deduction is sought. GG 88 • County Recorder
See reverse side for additional instructions and qualifications.
Appfirant� or contract buyer-sti ra,Clicbons on verse side) , )�
Tab trict Key number/legal desoip' Record number Page number
074-/c7-// -ZOO Cdo 7 '/ / OOH dot 3 aid
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appnrant the sole
March 1,anent year Meth 1,cu gent year date of application legal a equitable amen
000 ❑ yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
[ eat Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of ee or contract seller
Address or contract seller(number and street oily,state.and ZIP code) —_
Name of assignee or other owner or holder of mortgage 2 ' _
Address of assignee(number and street city:state,and ZIP code) Drawer NO Q 013
•
Does applicant own property in any other If yes,what county? • What' Q property
county in Indiana? ❑ No Card NO. B I ❑ No
❑ Yes'½E i/ a —/61 COUNTY AUDI 4 rJ 4`C�l
ed
Duction approved in the amount at
V
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
owner/contract buyer of the aforementioned property on date application is filed.
(owner's tun rr�ame1 ` - Date(month,day,year)
Fun resident address W 66plr'at' 'wt(number and street.OM,state,and ZIP )
IC ZaN L-- 6 awn r D c i`- . Lf 7
(e((9 . _ .
Person authorized by duty executed Pow4r of Ahomey or by IC 6-1.1412-0.7 Date(month,day,year)
Address of author zed person (number and street city,state,and ZIP code) .