HomeMy WebLinkAboutMortgage_Cooper (2)^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTE�IE,S� ownship vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
., . sr��a3�oscRniuos> N V 1 2 ZUl
y�. Rrsmbed by Departrtierrt of Local Govemment Finance
File Mark
INSTRUCTIONS:
,j�/ Form Aed w%h:
To be lled in person or by maii with the CounyAUditw or Counry Rcrnrder o! the counry where the propcNfy is o�ted. ,�
Fifirg Dates: 1) Real Property: Must file durirg the year Por which the deducUon is sought c��cn A.�OUNTY AU ITC�+ Cqunty Auditor
2) Mobde / ManuFactured Homes rat assessed as Real Property: Must fiie dunng the�ns�n+e (r mon[hs
6efore Maich 31 of eacA year the deduction is sougM1t. ❑ County Recorder
See reversa side (oradtlitional insWCGOns arrd qualficatbns. �
',. Appf°^t (o»+rer or convact buyer- see msbMm�e m rewrsa siie) /) .
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AIa�U 1. amM year
AaU
�i Iqr W�1d� 6 �16 ):IM CTdC� 5�1218 Oi Ill}CfPSi�
_ ,�s-3oa-Doo• baa -oaa
:/ Cantraa 4Me6te0ncs unpaid az W Mortgage / CanraU iMe!
artent yeer . tlate o( appfmatnn
tt �wrre m rem�d is QAtuenf Uun ihat af aDP�m• mEirate belav`
Nart�e ol rtartgagee w mntrarx se0er �/�
AAd�¢ss af rtnrtgage� ar rvntratl seDer (n aM sa
Name W astiyiee or other avmef or hoNer of ^art9a9e
PddRss W� (1` ye number and streef, ray siate, ar�o
/'�� a��
Dces e�m wm property in any oiher
sbm,
LPCOde) �
tt yes, what count�?
9 I ao 9 7
Is ihe applkant the sole
legal a eWita6le ame/7
❑ Yes ❑ No
�i OW11Bd WI1�150RICOIIG 01�18f �IdI15pO115C. Ifld�QfE N�ifl W�IOT
i5 CM P�DeRY in QueStion: MnuaDy Asse�xd
L$���nv ❑��N�
afl PT asP% � -�r �:4
'r1? Has iha dedu�m Deen re9uestetl m pmprity
� � � ❑ Yes ❑ No