HomeMy WebLinkAboutMortgage_Wilzbacher STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Towns
A hip Year
��FOR DEDUCTION FROM ASSESSED VALUATION g y
' c SWe Font.43709(R11 f fi-09) 11
Presaihed by Department of lnW GovemrtreM Finance
File Mark
INSTRUCTIONS: -
Fr•!' t S: IN
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I County Auditor
2)Mobile/Manufactured Homes not a�rrssed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is
ye sought
v144 1r_.- .er
GIB�e
See reverse side for additional instructions and qualifications. • ' • DiICR
Applicant rorw^ ,buyer-see r&strictions oneve ide) I , s n Fit. i,
zing _ O Key number/leejal desoi non Record number Page number
N...L_- • - - - . - be_ l3-a_ l
b.
•' >•value of real property as of -Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Ida•edness unpaid as of Is the applicant the sole
.•• 1,current year Ma 1,current year date of application legal or table owner?
1 (Pa � a / des ❑ No
If no,what is his/her exact share of interest? / If owned with someone other than spouse,indicate with whom 1
If name on record is different than that of applicant.Indicate below. Is the property in question:Annually Assessed
rV}((r`-R'Fal Property ❑Annually Assessed
Motile Bone(IC 6-1.1-7)
me of mortgagee or contract seller ^ _
O JN.L 11R��C� l a L
Address of mortgagee or�+!dh+Viy sea&(number and street,city,state,and ZIP code) /`'7^(/
Name of assignee or other owner or holder of mortgage — ✓
Draw
i�0•..//.]y.....
Address of assignee(number and street,city,state,end ZIP code) (� (� t a .•..••
Dees applicant own property in any other If yes,what county? , What Taxing C Car` ~O• •••S/h•.
county in Indiana? -
❑ Yes plc _ - - _...
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
owner/contract buyer of the aforementioned property on date application is filed.
Signatula full name) Date(month,day.year)
7-02 Fu resident address M Sppucant(number and street,city,state,and ZIP code) �I
kto /3 5 7 W. cio vud4/e (f llaubsiddi SN ,t)63q
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)