HomeMy WebLinkAboutMortgage_Cooley"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• SFate Form 43709 (R11 / 6�09)
ti w. � P�esrjibe0 by Departrrienl of lafal GOVemment Fi(tance �
INSTRUCTIONS:
To be filed in F
person a by mail wiN the CountyAUditor o� Counry Rewrder of the county whe2 the properry is located. ��2 ry QO�
Filrrg Dates: 1) Real Property: Musf file dunng the year (or which the deduclion is soughL � Coun Au i r
2) Mobde / Manuladured Homes irot assessed as Real PmpeRy: Must h7e during (he fweHe (72J months
before March 31 oI eacA year the deduction is sought. �a �t)h'. g� ��der
f.,ta
See reversa side toradddronal instruclions and qualificafions. �� �� .
IAppGwnt(ownerwrontr�rbuyzr-seeresMCnorismrererseside) h � . �n �y ""�v� :i ,�ITGr�
�_�
������o�
M2iM 1. paRnt year'
rc�.�c��i���or����
If name m rccoN is dMerent Nan that o( aDW�^�• mdinte bebvr.
ycry�
se�u
mortgaye
n l � RemN num0ej Page numDer
- . o��Da cY,
3a indehteEn�s unpaid az o( Mortgage / Con7ac[ indebteaness unpaiG as of Is Ne epp6vnl Ne sole
�ear date of appGCacron legal w ilaWe ownM
b � ❑ No
U wmea wim san,cone w,er u,an spo�sse. mawafe witl, whon,
Is e property in puestion: Mnualry AssesseE
eal Proaertv ❑ AmwalN Psussed
0.bdle Hartie (IC 61.1-7
sfale, aMZlProde)
(numberaMStree;rify,sfete,aMZlPCOde) � �
Oaes a�i�nt v.m property in any oNer
munty in Ind'aiu?
❑ Yes ❑ No
amaum
20
Src,runne W CaimryAUdaor
�, ZL.o9
It y�s. what coi �� O � �
��� �,�
\/�
� � n)
Counry
20 � 20
ctim Eeen rcVUesteE on 7�Y
n ❑ Yes ❑ No
Dale (monM. daY,
20
I I We ceNiy under the penalty of perjury Nat lhe above and foregoing infortnalion is We and cortect and that ihe applipnl is a resident of IrWiana aM
owner I contrad buyer of ihe aforementioned Droperty on date appfication is filed.
umwre r re�� _ /J o-a� �,�,�,m. aar. rean
iumber aM street,
�( S O^(,
by IC G7.1-t2-0]
ACtlress of autlmrrzed person (number arq stree4 �: slate.
c�'7G%a
dal: Y��