HomeMy WebLinkAboutMortgage_Cosby^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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= FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-W)
S- ` Presoi6eA by Department ol LaW Govemrtrent Firence
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�STRUCTIONS: � d6�
To be filed in person or by mail wifh the CountyAUditor or Counry Recorder of the oounty whele the property is located. FJU�� 2� � 2
Fil'mg Dates: 7) Real Pmperty: Mast hle durnig the year (or which the deduc6on is soughf. a �n Auddnr
2J Mobr7e / Manufactured Homes �t assessed as Real Praperty: Must file dunng tAe hvelve (12J months C�
be(ore Maah 37 0/ each year the Ceduction is sought. Co mder
See reverse side for additiona/ instrticfions arM qualifications.
MP�'a��ero� mnfrdC 6uye�i,seel restn'jWa o� rEverse sile) �i �
Ass�setl value d� popelty as d
MarM 7. armrt Spr
It ro, what 5 his ! her eratl
It rame m
rtnrtgagee a contraa seller
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�age / Contraa intlebtetlness unpaid as of
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'v�Gipte bebM^
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morcgagec w cantratl se0er (numbe� and sbeel, dfy, state,
Name o( assignee w o�er wmer or holder of mortgage
AEtlress ot assignee (number aM street �l: sbte, anA
Oces applimnt wm poperty in any oNu
counry in Intlana? ❑ No
❑ Yes
,
DeduUion approved'c� tlw amount af.
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If yes. whal
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NTat Tadig �iStriClT
Recortf numher
unpaM a5 W
numbu
iitade ownell
Yes ❑ No
sUOn:MnuellyASSessed
❑ nrmua�yAssessea
Has Nis deEUCion 6een requestetl m pfoprJly
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I I We certify under Ne penalty of perjury that the above and foregoing infortnaUOn is true and mn
owner ! conVact buyer ot the aforementioned property on date appiication is filed.
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I` F ' ent adAress o1 appGtanl (ni
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Pelson auNOraeE Cy dWy exewtetl
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Adtlress ot authw'aEd person (numberaM sbee( dry, stdte, an0 ZIP oode? �
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