HomeMy WebLinkAboutMortgage_Cox (13)a�� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°+"�'-° = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�� y State Form a37os (Ra I 10-07)
Prescribed by Departnent ol Local Govemment Finance
INSTRUCTIONS: ���((( ���777 r.�ile•`��((
To be (led in person or 6y mail with the County Auditor o/ the county whe2 the property is I�d� ��j.-.� �
Filing Dates: 1) Real Property: Dunng the 12 months be/ore May 17 0l the year the deductio s o e ct ve� �
2) Mobile Homes assessed under IC 6-1.7-7: Behveen January 15 and March 3 0l the year the deduction is to be elfective.
See reverse side for additional instructions and quali�cations. N O V O�_ Z�OZ
Applicant (owneror
Distrid
6uyer
Assessed value of real properiy as of
March 1, wrrent year
restnctions on
If no, what is his / her exact share of interest?
Key /�urnber / legal
60 / -b /�'-�-OC�
MoAgage / Contracl indebtedness unF
March�rent year
If name on record is different lhan lhat of applicant,
of mortgagee or coniract seller
G!OSO�d COU`!'v
Record number � �
Pagenumber �al
as of Is the applicant the sole Iegai or equitable
owner? ❑ Yes ❑ No
O o c'� �
If owned with someone other than spouse, indicate with whom.
�G_�U_8./�o-do/. $30-60/
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? I What Taxing Distrid?
county in Indiana?
approved in the amount of:
20 k j_
Signature
20
COUNTY AUDITOR
20 20 20
�
County Auditor
Has this deduction been requeste�on
property for wrrent year?� Yes❑ No
20 �� 20 �`�
P �
Date
\��� �
certiy under the penalty of perjury that the above and foregofng information is true and corred and that the applicants was / were
lent o( Indiana and owner of the aforementioned property on March 1, 20
ire (ow ers 1 name) A� ^�� Person authurized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
resident
of authorized person