HomeMy WebLinkAboutMortgage_Cox (9)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
f: r
� FOR DEDUCTION FROM ASSESSED VALUATION
Sate Fortn 43709 (RB I 2-07) �.
�� ��w r Aescribed by Departmenl of Local Govemmml Finance
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INSTRUCTIONS:
To be filed in person or by mad wdh fhe CountyAuditor o/ fhe wunty where the property is bcated. AU G j j j 0(��
Fding Datas: 7) Real Property: Dunng the 72 months be(ore June 11 d the year the deduction is to be elfec6ve.
2J Mobile Homes assessed under IC 64.1-7: Behveen January 15 and March 2 0/ fhe year fhe deduc6on rs fo be e9ective.
See reverse side (a addifional ins6uttions and qualifications. �a�„ ��a-��,
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Assessed value af r� popaty as of March i. arrent y�r Mo�gage I ConUad indebtetlness unpaid as of Mardi 1,
ninenl year �i i1 /7 � �
(�(O( �
I�what is his / her erzacl share ot interesl? If wrtied wiTh someone ot}
If �ame on recard is difierent than Ihal of applican4 ��ipte below:
ot mortga9ee or conVaG seller �
Address of mortgagee w conUact seller (num6er aiM atieef. dty, sfate, ard Z!P code) /
or oUier owner or hdder of mortgage
Address M assigree (numbet aM s4eef, dty, ffiate,
Dces applicanl wm property in any �
courLLy in Indiaral
❑Yes C
Oeduction apprwetl in the amwnt �
20 1
S' t re of Couny P
I / rtify n
Indiana and o
$iq110tur�( �wn fu
Y-� �
�,iaent ddress
C
Pason auttnr¢ed by
�
What Tadng DisUict?
Drawer NO. a��
.......
Card NO. ,,,.,�`�, y�3
��j '150.�.
Counry
20
1 3
Remrd number Page numb
O '
Is Ihe appfitant Iha sde legal a equitable owrre(1
❑Yes' ❑ No
spousa. indicate with whom.
Is Ue property in quesUon:
❑ Real Property ❑ Mobile Home QC G7.1
2�
oale
ues�ed on property
❑ Yes ❑ No
20
the penalry af perjury tliat the above and foregoing infortnation is We and correct and tliat ihe applinnis was / were a resident oi
of the aforementimed propeAy on March 1, 20 _
��� � Dale (month, day, yean
(number and s6eet city, state.
a by IC
peisan (num6er arrd s4ee; crty. sfate, arnd Z!P code)
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(monlh. daY Y��