HomeMy WebLinkAboutMortgage_Cooper'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Town hi Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R71 / 6-09)
� y„ Presaibetl M��M oT Local Ccvemmem Friance
File Mark
wsrRUCnoNS:
A .
b be filed in person w by mail wiM the CounryAuditor or Counry Recader of the counry where the property is located.
Fifig Dates: 1 J Real Pmperty Must file durmg Ne year (or which Me deduction is wught � Coun Auditor
2) Mobde / Manufactured Homes rat assessed as Real Properfy: Must Ae d�uing the twelve (12) months
befae March 31 0( each year Ne deduc0on is soughL � ��
See reverse side /or add'RiqPal instructiwis arM qualifications. GIBSO �
� � {
AsseseCra4xaFreal P�er,yesd ' M1brtpa /(
Me�d� 1. aim¢ year Metd� a�
�
tl no. what is h's / Icer euC Share of int�t?
If rwne m remN is diRe2n1 Man Nal of app�ni, 4Wkate Ce
Name of �ea m m�vacl seNer
Pddress d mort�a9ce w mnaaG seLer (numbrJ end sbee; r�
Name of assi�ea or othu awner w holder N rtrrq7aga
Pdd�ess of assignee (number and stree; ray. sfete,
Does appti�a ovm WcD�Y
muntv �n Ind"eru?
amount of
20 _ � 20 _
' �%� • .�U
"udebteC�ress unpaid as of Mortgage I CorCtatY
v Oateofapp6ptirn
RecoN
is tlre eppOranc Cre sde "
legal «eQuitade oarwft
❑ Yes ❑ No
sPOUSe.'udkate with whom
Is tl�e prope.rty in QuaEOn: MnuaDy Asussed
� Real PruPe�i' ❑ !�!�Y �
� Drawer NO...v2:�. � �......
9 �a71 � \jO. .....� � 1 1
- ...........
: � � 5; i3o, c�8
20 _ � 20 _ I 20
dr�umni Daen (eQUested m P��Y
� � ❑ Yes ❑ No
�_ �_
Date (rtionth. OaY. Y��
I I We certify under the penalry ot perjury Nat Me above aM foregoing infortnatlon is true and correct and Mat Me applirant is a resident ot Ind"ana aM
wmer I contract buyer ot the atorementioned property on date aDW��n is filed.
�rcawre (ou�rers hAI reme}� Date (/nw+N. daY. YmeA
Pason aW�ai�etl hY ditly exewted
Ccson (number aM stree4 �% 5bfe, anC LP mde)
1�h. _ _
_ . : - ,1_
---- �