HomeMy WebLinkAboutMortgage_CoburnSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
" ' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ow��ns,—h�ip Year
�, .«• � State FOrtn 43709 (R4! f0-07) � �
PresqiEee by Department of Local Govemmeni Finance
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INSTRUCTIONS: �AY � yFifelGtark
To be filed in person or 6y mail with the County Auditor of the county whe2 the praperty is located_�
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0l the year the deduction is to be eNective. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 o�r the de � ucY[io��ul�Hective.
See reverse side (o� additional instructions and qualifications.
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Applicant (o e or contract 6uyer- see restrictlon$ on verse side
Taxing Disirid Key number / legal description Record number ��
QQ ��/� Jf )�3� "� Page number 406
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Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, currenl year ownef? ❑ Yes ❑ No
I( no, what is his / her exact share of interest? If owned with someone other lhan spause, indicate with whom.
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If name on record is difierent than that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobiie Horrie pC 61.1-�
ame of moRgagee or contrad seller �y , p,3 -<f b�,
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Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eef, city, state, ZIP code)
Does applicant own property in any other if yes, what counry? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for curtent year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20v 20 20 20 � 20 � 20 �
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Signature County Auditor Date
,\/ We certify under the penalty of peryury lhat the above and foregoing infortnation is true and corred and thal ihe applicants was / were
� resident of Indiana and owner of the aforemenlioned property on MarcF� 1, 20
n ture (owners /ull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
I resident address af applipnt Address of authorized person
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