HomeMy WebLinkAboutMortgage_Cox (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co vear
__ : FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6-09)
�' ,�,� � Prrsaibetl by DepartrtieN o( laal GovemmeM Firence
File Mark
INSTRUCTIONS:
FEB F � ���,�:
To be filed in person or by mai/ wiN tlre CounryAUditor or County Ri;corde� o71he tounty where the property is localed.
Fi/irg Dates: 1) Real PmpeRy: Must file durirg the yearlor which the deduclion is sought. � Coun Audimr
2) Mo6ile / Manulactured Homes �rot assessed as Real Property Must file dunng fhe fweNe (12) month's7�7 ry
before March 31 of each year the deduction is sought. /�' � a �iP.ounry Recorder
V
Seereversesideloradddionalinstfuclionsandqualifications. GIBSON C
qppG�'�(owneror // b/�°fQ � i'71�
� IOCV� O� .�
ws�ssea vaWe oF real prapem as a
rv��Qi 1. amnt year
11 rw, what Is his / her exaq share O( interest?
m
mMgagee w
7 -(JV (/ ' �V
irWe6tedness unpaid as ot Mortgage / Connaq inCe rmss �mpaid as af Is Ne app6ranl Me 5We
r tlateotavP�m� kgalaeWitaHeowneR
❑ Yes ❑ No
If owrred with someone other tlun spouse. iMirate weh wlwm
�
Addtess of mortga9ee ar mntraa seQEr(7fumber eM svee; ciry, sfate, arM Z/P code)
rvame m azsgnee or omer awner or rnaer rn mortgage
Pnaress o� assgnee �numuer ana suee; ory, seie,
any otner
Yes ❑ No
D�uclion appoved In the amoum ot
20 _ � 20 _
Signature N Counry Auditor
yes. what county? I What Taz
" COUNNAUDRC
Is Me property in QueStion: MnuaOy Asessed
� Real Roperty ❑ Armualh�Assessed
C�U,� /�/� AC a C_. ~ -'-
`�u l��n� A,�J,J
� b� � 6i� Na
20 _ � 20 � 20 � 20
Date
LV
I I We certify under the penalty of perjury Nat Ihe above aM toreguing infomwtion is We and cortect arM that the applirant is a resident of Indiana aM
own�.l�contracY buyer of Ne afwementioned property on date applica0on is filed.
re wne/s /u/J Mme) �. /.� Date (rtmfi. daY, yaan
Person auNO�rzed by
oi auNa'sN person (numberantl snee; tqy, state, an0 ZIP code)
Date (monN. daY YEa�