HomeMy WebLinkAboutMortgage_Cooper (7)f�yA� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
s, J State Form 43709 (R6 / 5-06)
� Presrnbed by Department of Local Govemment Finance
INSTRUCTIONS: FEB �S �
To be filed in person or by mail wdh the County Audito� of the county where the property is /ocated.
Filing Dates: 1) Rea/ Property: During the 12 months before ,lune Il of fhe year fhe deduction is to be effeclf ve.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year th�'�de�ti�� be eHective.
See reverse side for additional instnictions and qual�cations. GIBSON COUNTY AUDITOR
Applicant er or contract buyer- see restrictions on reverse side)
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Taxing Distri Key number / legal description Record number
ai/o -l7-�+1- d-o0- vo�. 0$
8 � � Q � / Page number
Assessed value f real prope s of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year ownert ❑ Yes ❑ No
/a7,9/b'
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on rewrd is different than that of applicant, indicate below: Is the property in queslion:
O Real PropeAy ❑ Mobile Home QC 61.1-�
�e of mortgagee or contract seller � � /� S - �� 1'�� � � ///, �, � Q _ ,
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Address of mortgagee or conVact seller (number and st2et, aty, state, ZIP
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code) O;?t �'��
a"er�0.'.
Dces applicant own property in any other If yes, what county? What l DC `a�'' � sted on
county in Indiana? Cara�O• �;0�,9�� � res❑ No
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COUNTY AUDITOR
Deduction approved in the amount of:
20�_ 20 20 20 20 20 20
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Signature County Auditor Date
� We certify under the penalty of perjury that the above and foregoing information is lrue and correct and that the applicants was / were
sident of Indiana and owner of ihe aforementioned property on March 1, 20
Si n�lure (owners (ull a"1) Person authorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
��sjdePj aQrQr��s 'oj,appl� � n - - ��5 � //Q Address of authorized person
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