HomeMy WebLinkAboutMortgage_Wilson (2) �_a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township yr
1" FOR DEDUCTION FROM ASSESSED VALUATION ; '�
c::'.V.a'• State Fenn 43709(R11/6-09) j if
�.; Presmbed by Department of Local Government Finance � � f
File Mark
EOM DFr•� ,-'.
INSTRUCTIONS: _
Fo filed with f.. 7'
To be filed in person or by mall with the County Auditor or County Recorder of the county where the property is located. ! Q
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought El Co •0.• ditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months f _ f r_
before March 31 of each year the deduction is sought �'t `-'•';� 1��---
See reverse side for additional instructions and q Iifications. COUNT Y/}U
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% P� number
(fe- 002 Ja4oaO. 9.53 number 53 %
Mortgagge/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is die applicant the sole
March 1:- March 1,cement year date of application legal or equitable owner?
❑ 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
❑Real Properly ❑AnnualhyAssessed
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Miter Home(IC 6-1.1-7)
tJame of mortgag contract seller (�///,'r��/�,�.{,J��n '�'11��
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
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested an property
county in Indiana? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County Date(moth,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed. .
signalownerts c rwn9 IA)) Date(month,day,year) y
qi-`I r F / yO U\ of ce ljnumberaps / st 1- Pm )te6-1.1-12-0. /i� c/-7(0(,.0
Person authorized by duty executed P oweroffAttomey or try IC
Date(month,day:year)
•
Address of authorized person (number and street,city,state,and LP code)