HomeMy WebLinkAboutMortgage_Cooper e }}•\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I
/1 • .,_i ? FOR DEDUCTION FROM ASSESSED VALUATION
.
itt; 't State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. I nn rt
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is soug T
Must be filed with the County Auditor or County Recorder of the county where the property is loca 11 C• uditor
on or before January 5 of the immediately succeeding calendar year. 1111 Jl Lou Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(72)months before March 31 of each year the JU L 2 22013
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) /)/ n
CHRISTOPHER COOPER AND EMILY HIRSCH �l7wl(�rnV,'^'7"�'',`�,^^^
Taxing District Key number/legal description GlBSQ$lcc rY A1/$12: 1314.415er
HAUBSTADT 26-18-36-404-000.468-009/LOT 103 BLOCK A WEST HEIGHTS SUB I//3 I G
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1.current year March 1,anent year date of application legal or equitable owner?
113,200 Fl Yes ❑ No
II no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Accessed
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HERITAGE FEDERAL CREDIT UNION
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
5388 OLD STATE RD 66 NEWBURGH IN 47630
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state.and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month.day.year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
nature(owner' full name) Date(month.day,year)
• r bj �/ / 0771212013
Full resident address of apps' nt(numbe antl e(city,state,and zIP code)
103 S WEBER DR HAUBSTADT IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city.state,and ZIP code)