HomeMy WebLinkAboutMortgage_CochrenR� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
f�' 1'f FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Fwm 43709 (RS / 4-03) - 1 ' ' - � , � .
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PrescnDCd by Department of Local Govemment Finance �j � �
INSTRUCTIONS: SC N File Ma�icUU�
To be filed in person or by mail with the County Auditor of the county where the property is located. �� „
Filing Dates: 1) Real Property: Dunng fhe 12 montbs before May 11 of the year the deduction is to be�effective.� ��t ��
2) Mo6ile Homes assessed underlC 6-7.1-7: 8etween January 15 and March 2 olthe yearthe deductiomis to`be.eHective.
C'.3�ON C_,..- _ _. , .
See reverse side for additional instructions and quali�cations.
Applicant (own rcont ct buyer- see rest�ns on reverse side)
d
i axing uisinct Key number / legal
��.e�, ,
Assessed value of real property as of - Morfgage / Contrect ir
March 1, current year March 1, current year
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
��e of mortgagee or contract seller .
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount o(:
20
20 0,�
�
�
Record numker
o`3-�a��
Page number
r-
unpaid as of Is the applicant thy� sole legal or equitable
owner? �Yes ❑ No
If owned with someone other than spouse, indicate with whom.
�5y
❑
in question:
y ❑ Mobile Home pC 61.1-
state, ZIP _
--
)rawer NO... V 3•' .. �'�'j U
.....
:ard NO . ................
WhalT: _._.......,,� �oquested on
� property for current year?� Yes❑ No
COUNTY
20 ��
�
County Auditor
r� +;
�
20 �'L 20
P
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was I were
lent o( Indiana and owner of the aforementioned property on March t, 20
applicant
ro� �,vdi�9ti �
/ �%/.IiC.- /J
Person authorized by duly execuled Power of Atiomey
or by IC 6-1.1-72-.07
of authorized person