HomeMy WebLinkAboutMortgage_Willis STATEMENT OF MORTGAGE OR CONTRACT IND •1•�1• Township Year
,t:_? Er -
FOR DEDUCTION FROM ASSESSED VALUATION ► {
• State Fonn 43709(813110-15) g
te.sit Presorted by Department of Local Government Finance ale INSTRUCTIONS: OCT 3 File Mark
lb be filed in person or by mail. Fonn filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the •.>fJ ,«. 1.13. •i
Must be filed or postmarked with the County Auditor or County Recorder of the••II( 5 '4; ••,i County Auditor•
located on or before January 5 of the immediately succeeding calendar --.u;•
2) Mobile/Manufactured Homes not assessed as Real Pro Must filet' Co COON County Recorder
where perry: r�k1 ofe each yea Auditor of the county
property is located during the twelve(12)months before March 31 of each yearthe deduction is sotghL
See reverse side for additional instruction and qualifications.
Applicant er or contract buyer-see restic8nns on reve side
a--T Ain R t in o Qom,
Taxing D" Key number/legal description Record number Page number
C a Rto- HI - I9- ao3- coo r3 So on to /6 /94,0
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or
e8 equitable owner?
/4.7a-j ❑ 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 ddiraent than that of applicant indicate below Is the property in question:Annually Assessed
Real Properly ❑ Annually Assessed
• Mobile Home(IC 6-1A-7)
Name of mortgagee or contrrameller .sa
Address of mortgagee or contract r and abed,city,state.and ZIP code) —
Name of assignee or other owner or holder of mortgage --
0 ILLS t
Address of assignee(number and street dry,state,and ZIP code) L
ps�'LL7
M�appnli aly nt own property in any If yes,what county? What Taxing District? I. O n t (deduction
in Indiana? ❑Yes ❑No J (//-�(1/11 /('' /
A person is not enb7led to this deduction unless the person has a balance on the per i l — � l (O 1 the county
recorder's office(including any home equity line of credit that is recorded in the coup (O
COUNTY AUD -
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Data(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 I contract buyer of the aforementioned property on date application is filed.
Swats full Date(month,day,year)
%1� ,� .e t n rob /ateyjap10
Full rAcid.rd/ , tha Men?r Za��uactd a , H. )4fl Qao -
Person authonzed by duly executed Power of Attorney by IC 6-1.1-12-0.7 �(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. _