HomeMy WebLinkAboutMortgage_Cochran!"� :.
, �1(
,��� _
i�
f,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortna3709 (R4l 10-01) __
PrescriDed Ey Deparvrenl of Loral Govemment Finance ��� 1
��
�J
INSTRUCTIONS: A 2003 File Mark
To be filed in person or by mail with the County Auditor ol the county whe�e the propert}��ic�
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 o/ the year the deduction is to 6e effective. n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 aq�,87Narch 31 ��ear t�uction is to 6e effective.
See reverse side for additional instructions and qualifrcations. C� .. /_., .��.,� ; nG �.
� � G;ESOtd c��„. , : -..,.,.. _
Applicant (owner contract buyer- see�tricUons on reverse side)
l�./�`-'�--�
Taxing Distrid Key number / legal description Record number O�
O/�� Q/Y� y,{�� Page number
� l/ � 'lJ
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant he sole legal or equitable
March 1, curtent year March 1, wrrent year ownef? ❑ Yes ❑ No
��
If no, what is his / her exacl share of inierest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicale betow: is the property in question:
❑ Real Properiy ❑ Mohile Hmie QC 61.1-�
�me of mortgagee or contracl seller
Address o( mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yea(? ❑ Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �,� za zo zo O� zo �'� zo �0 _ zo o Q
P d�— � � P P
Signature County Audilor Date
'/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and correct and thal ihe applicants was / were"
� resident of Indiana and owner of th forementioned property on March 1, 20 -
Si nature (o ners full name) Person authorized by duly execuled Power of Attomey
Oor by IC 6-1.1-12-.07
r sident address of applipnt Address of authorized person
� �.