HomeMy WebLinkAboutMortgage_Cooper....�,.
��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s' FOR DEDUCTION FROM ASSESSED VALUATION _
�/ State Farm 43709 (R6 / 5-06) - � � �
:/ Resai6ed by Department of Local Gavemment Finance
�
����I
I� j ' � ;.j ■.
INSTRUCTIONS: NOV 3 0 ��an�
To be tiled in person or by mail wrth the County Auditor o/ the county where�the prope�ty is /ocated.
Filing Dates: 1 J Real Property: During lhe 12 monfhs before ,lune �7 0/ the year lhe deduction is to be tive./�y
2) Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the ye r ortc�is to be effective.
See �everse side for additional insfnictions and qualifications. GIBSON COUN7Y U0170R
contract
Taxing
on ieverse
/ legal description
� / -
Assessed value af real property as of Mortgage / Contrad inc
March 1, wrrent year March 1, curtent year
:, _.
Ii no, what is his / her exad share of interest? ' If
If name on record is difierent ihan that of applicant, indicate below:
mortgagee or contraC selier
Addresa of mortgagee or contrad seller (number and street, city, state, ZIP
Name ol assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
0
Record number �
Page number
unpaid as of Is the applicant the sole legal or
� ownef? ❑ Yes ❑ No '
wilh someone other.than spouse, indicate with whom.
Does eppficant own orooeM in anv nth.+� I ir..o� ...�.�� ....� ��Ty,� What Taxing Distrid?
county ir
Dra���er NO..� �.-.��.��
COUNTY AUDITOR
Deductioi Card N0 . .....................
2� � I 2� � I Z� 2� _
Signature County Audftor
20
Is the praperty in question:
❑ Real Properly ❑ Mobile Home QC &1.
9
Has this dedudion been requested on
property for wrrent year?� Yes� No
20
�
cerlify under the penalty of peryury that the above and foregoing information is true and corred and ihat the applicants was / were
ient of Indiana and owner of the aforemenlioned property on March 1, 20
�
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
� FWi rBS�Oent atltlress ofapplicant Address of authorized person
l�zS Ig�SGc) �iYi/fih �U 5�7G/G
��