HomeMy WebLinkAboutMortgage_Cook`' �� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e"" � FOR DEDUCTION FROM ASSESSED VALUATION
S / Slate Fwm 43709 (R4/10.01) - � � i � '
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PrescribeA by Department ol Local Govemment Finance
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lNSTRUCTIONS:
To 6e filed in person or by mail with the County Audifor o/ fhe county whe� the property is located. �
Filing Dates: 1) Real Property: During the 12 months 6elore May 11 01 the� year the deduction is to'be effec('�R. �1-5 2004
2) Mobile Homes assessed under IC 6-1.1J: Befween January�l5'and March 31-o/the year-the deduction.is'to�be eHective
See reverse side foradditional instrucfions and qualifications. l�� � � // n
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�uwner ar conrracr nuyer - see
Taxing Distrid I �
� Ce�,-fier 1 owv�s'���
Assessed value of real property as of
March 1, curtent year
what is his / her exacl share
smcnons on ieverse side) �
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Key number / �egal description
,
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Mortgage / Contred inde'.
March 1, current year
7-�a
�dness unpaid as
Kecord number
Page number' ? ' '
,
Is the a
owneR
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e legal or equita
•:OtNo
' la�,o�D ��
If name on record is diHerent lhan lhat of applicant, indicate below:
Vame of mortgagee or contract seller
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Address of mo gagee or contrect seller (number and st2et, city, si
2( S� 3h.!C � v4 �� �
Name of assignee or other owner or holder mortgage
Address of assignee (numbe� and sVeet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
20
Signature
aNywvcV 111 pIC tlfllOUpl 07:
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If owned with someone other than spouse, indicate with whom.
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� � � ��Real Propert'y :,�0 tvloale�Fiome (IC 61.i
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COUNTY AUDITOR
2o s� zo o� �o,�
P P i
County Auditor Date
. 08= I �l�.y , l - L
�t? Has this dedudion,been requested or
property for current year? � Yes � N
zo
� I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
,1 oignatur wners /ull naj�'�C Person authorized by duly executed Power of Attorney
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Fil i n `
� RR I 4oX267, Prin�efiot�
autnonzea person
,