HomeMy WebLinkAboutMortgage_Cochren (4)^`� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__,. • FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R77 / 6-09)
�` S Pmsrribed by DepartmeM of Lttal GovemmeM Firence
�� File Mark
JSTRUCTIONS:
To 6e frled in erson w 6 maii vntA the Coun Auditw or Coun Recorder of Ne coun where the F ��
P Y �Y �Y ty property is located.
Fi7irg Dates: 1) Real Pmperty Must file during fhe }rear (or which the deduction is sought.
2) Mobi7e / Manulactured Homes not assessed as Real Property: Must file dunng fhe twelve (12J months
6efwe March 31 of each year the deduction is sought Counry Recorder
See reverse side for addrtional instrucfions and qualifications.
-see
r
-�„i�
what's his / her e�ct share o( inferestt
If name m record is tliRerent than that ol appti�ani.
Name oi rtartgagee m m�tracl
^V �
Contraa irde6tetlnrss unpaid az of Mortgage I ConVa
rfen� dateofappGmtion
' _1 n �. \
contraa seDer (num6er aM sfree4 ��i: s+ete.
G'1.
o .. UNT � �
unpaiA as d Is Ne applirant Ne sale
legal n equltade ame(�
❑ Yes ❑ No
If avmed with someone dher Ihan spouse, iMimte wNh whom
Name of assi�nee w other owner or twlder of rtwrtgage
MCress of assgnee (number and sLee4 mY. �e, antl Z/P cotle)
Dces applimnt own pmperty in any oNer If yes. what munry? Whal Tari� DisGict7
counry in Intlana? ❑ Yes ❑ No
I COUNTYAUDROR
D�uction approved'v� the amoum ot
20 20 20 20 _ 20 _
SigfaWre W Camb Auditor I Counry
Is ihe property in Question: Mnualty Assessetl
❑ Real PruPeM � Mnually Psse55ed
Mable Harie fIC 6
Has Uis deducGm Eeen requeste0 an property
for artent yeaR ❑ I
❑ Yes
20
I�%St'
20
I/ We certify �rWer the penalry of perjury that the above and foregoing intwmalion is We and cortecl and tha[ the applinnt is a resident of IrMiana aM
owner / mS�`�b�yer of the aforeme�p �tlQned property on date apDlication is fiied.
)�Wre �merY hN �� � � _� � � Date (monfh. deY. Yaa�
sbeet
Psson autho�0 Gy dWy ezecuteE
person (numberarM sbee4 ary. sb1e, anAZIP coEe)
Oate (month. daY. Ye�