HomeMy WebLinkAboutMortgage_Wilson (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t.,,t.- FOR DEDUCTION FROM ASSESSED VALUATION y
}•s State Form 43709(R13/10-15) TT
Pres<rtbed by Department of Local Government Finance g J
INSTRUCTIONS: File Mark
To be filed in person or by mail. AU, F° iflint:
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. • ■' '.i • -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the noun 1. •. — MIS;
where the property is located during the twelve(12)months before March 31 of each year the dedudreSSi A COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Apprxanl(owner or at seerestruu(( ns V ^� ,�YL
Taxing District 4 - 2^�2 —orb-aoo - oy/o• n! po-W Q Record
Page number
l
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appy scam thl/ee stil
h e
assessment date,amend year assessment dategrrent 7::airivp data of application legal or equitable owner?
�I ❑ Yes ❑ No
it no,what is his I her exact store 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
5 �3 ❑ Real Property ❑ AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Marne of assignee or other owner or holder of mortgage
�l� `)- Oil OA,JD�A say
Address of assignee(number and street,city,state,and ZIP code) lN1
in Cc vIP
Does applicant own property in any If yes,what county? If yes,state amount of deduction
other county
in Indiana? ❑Yes El No /�0_ 2Q/ r/
.4 person is not entitled to this deduction unless the person (l �J(J(D`� ss that is recorded in the county
recorder's office(induding any home equity line of credit th _ . __._._r the deduction.
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 I contract buyer of the aforementioned property on date application is tiled.
Signature(owner's fun name) Date month,day,year)
3 - IV
Full resident address a t(number and sheet city state. ZIP code)
Sit address On.e. LA •x Dr .�n. 4 763q
Person authorized by duly execute ower of Attorney or by IC 8-1.1-12-0.7 Dale(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 hall years and a fine not to exceed$10,000.