HomeMy WebLinkAboutMortgage_Cochren (5)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
1 ,� State Form 43709 (RS / 4-03)
� PrescriDed by Department of Local Govamment Finance
Coun Township Year
� � d �
g � �v �.i
INSTRUCTIONS: F1',I �vJ,ark
To be filed in person or 6y mail with the County Auditor of the county where the property is located. S E P 2 6[�Ub
Filing Dafes: 1J Real Property: During the 12 months be7ore May 11 olthe year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yearlhe deducsion is to be effective.
p�rc�. N �
See reverse side for additional instructions and qualifications. �/ �
GIBSON COUNTY AUDITOR
Applicant
Assessed value of real property as
March 1, current year
see restn ons
�u n
Key number / legal description Record number
�G �a-a�-3oo-00� ��� 0�7
v U(�— C� /�7 � -OC) I
MoRgage / Contred indebtedness unpaid as o
March 1, current year �y) D��
�0 0,4 D?�
If no, what is his / her exaa share of interest?
If name on rewrd is diHerent than that of applicant,
of mortgagee or contrad seller
Address of mortgagee or contraIX seller (number and street,
betow:
Page number C�
�
Is the applicant the sole legal or equitabie
ownert ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
state, ZIP
s the propeRy in question:
❑ Real Properiy ❑ Mobile Home (IC 61.1-�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, citv. �'�'� —
y� ►�E � a�� �s� .
Does applicant ov, � � Q pe N Nhat Taxing Districl? Has this deduction been requested on
county in Indiana % � property for current yeaR � Yes ❑ No
5 N� �`'� -�'��
20
Signature
approvedi
20 �
i
O � ' � _..uNTY AUDITOR
20 �� 20 20
P
County Auditor
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
:ss of
'��
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person