HomeMy WebLinkAboutMortgage_Cochran (3)f��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' '= FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
� � / State Fwm 43709 (R6l 5-06) �
Presaibetl by �epariment of Loml Gwemment Finance
INSTRUCTIONS: MAR We
4n6�i9
To be �Ied in person or by mail with the County Auditor of the county whe�e the property is locafed.
Filing Dates: 1) Real Property: During the 12 months before June 11 0/ the year the deduction is to be eflecti�yy/ ,Q
2) Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year the d�(fii ic�i is (���[�'ve.
See reverse side for additional instructions and qualifications. G�BSON COUNj
Appliwnt (owner
Taxing DisUid
Assessed value of real
March 1, curtent year
buyer-see
as of
If no, what is his / her exact share of interest?
If name on record is
mortgagee or contrad seller
reverse side)
�
Key number / legal description Record number �-'
q ar� �
a(Q-Ia-O'1-�-164'�•3 \I— genumber r�/ �
U
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curtent year owne(? ❑ Yes � No
l� �
If owned with someone other than spouse, indicate wilh whom.
indicate below:
✓/
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name ot assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amouni of:
20�� 20� 20
T
Signature
What l
COUNTY AUDITi
20
County Auditor
s lhe property in questian:
❑ Real Propeity O Mobile Home pC 61.1-�
0°�00 7- 5 3� 1�
`� `� 7� l0 00 • `�
� � � 1 �1
1 �
� � • •
I
:d on
❑ No
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
S'Ip�f(�ature (owners full name)
/` �l _ . � /r il
FyII r�siden[ address of applicant
7�/1..,_ �,L �° /'�n.
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person