HomeMy WebLinkAboutMortgage_Cornwell�,:�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION � T ear
v,w� .> State Form 43709 (R6 / 5-06)
� Presai6ed by Department of Lonl Gwemment Finance 4 2008
INSTRUCTIONS: ��+°�.
To be filed in person or by mail with the CountyAudito� of the county where the propeRy is located. � v
Filing Dates: 1) Real P�operty: Dunng the 12 months befoie June Il o( the year the deduction is to be ef/�i$§�N COUN7Y AUDIT�R
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to be eflective.
See �everse side for additional insfrucfions and qualifrcations.
Applicant (o � or contiact buyer- see restrictions on reverse side)
Ta�cing Distri K numb / I description Record number M�
Page number w
�La., ��-o5-vo-i9y-oc�.o9y -6a � 8� v�
Assessed value ot real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cunent year ownef� �Y � No
�7a5o
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: Is the pro erty in question:
❑ ❑ Mad7e Harne QC 61.1-�
e of moAgagee or contract seller c;
�J
Address of mortgagee ar conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing District7 Has this dedudion been requesled on
county in Indiana? property for wrrent year?� Yes� No
COUNTY AUDITOR
DeducGon approved in the amount of:
20 �_ 20 �_ 20 20 20 20 20
1 `
Signature County Audttor Date
We certiry under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
asident of Indiana and owner of the aforementioned property on March 1, 20
Si natur (owners (ull name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full r sident dress of applicant �—� �? � Address of authorized person
�'/ 2 N a,-, s