HomeMy WebLinkAboutMortgage_Wilhite (3) fa,: STATEMENT OF MORTGAGE OR CONTRACT INDE County Township Year
FOR DEDUCTION FROM ASSESSED VALUAj(t0
': State Form 93709(R11/6-09) &11 11Ia
Prrsmbed by Department of tncal Govemment Finance
OCT 2 9 2014 Fie"a'
INSTRUCTIONS: -
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the props is located.
Ffng Dates: 1) Real Property.Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file d,h}',,, 412)months
before March 31 of each year the deduction is sought P4 laTY AUDITOR County Recorder
See reverse side for additional instructions and qualifications. GIBSON COON
App ow bz see resntbpps misYfe}.� / JC-1,, / �(
T /h� a6 her/ al d0� .,59L-In-°Q k Record O)QJ 9 Page number ao
Assessed value of real property as of Mortrtgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1;current rear I March 1,current year date of appFIcation legal or equitable owner?
/3 a ❑ Yes ❑ No
If no,what Is his/her exact sham 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
a:al Property ❑ 6-1.1-7)
Name of mortgagee or contract seller / .S.7 ?� _
Address of mortgagee or contract seller(number and street city.state.and ZIP code) - • 1 - - _
Name of assignee or other owner or holder of mortgage t/_ i_.�• a
Address of assignee(number and street dty,state,and ZIP code) ��J,fJ� CO 111. .....
Drawer NO.. . .. •. .
Does applicant own property in any other If yes,what county? - property
county in Indiana? ❑ Yes ❑ No
� ❑ No
Card NC) ...s ................rot
COUNTY A
`-'�"
Deduction approved in the amount of: - L 13c 1
ed
20 - 20 20 20 20_ 20 20
Signature of County Au ilor County Date(month,day,)ear)
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
er/contract buyer of the aforementioned property on date application is filed.
re(ovine : = ..) of
Si /fDate(month,day,War)
dent /ry:p.' t(number and sheet.city state,and ZIP code)•
I/gat«aye "my>7 to rs>Lo"Prr ✓1 IC 6-1.1-12-0.7 f._) 4 7/a 7 0 Date(month,day,yexecuted Power Person
Address of authorized person (number and street dry,state,and ZIP code)