HomeMy WebLinkAboutMortgage_Cox (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court �j��ryy 'j171 ty--r
FOR DEDUCTION FROM ASSESSED VALUATION it•
•State Farm 43709(R11/6-09)
Prescribed by Department of Local Government Finance 1^le tl 20 Y
A
INSTRUCTIONS:
Form toned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months BSO V C®1 Na` ,Ik/3ZPCbr@{it
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
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Taxing D' Key number!legal besaiption Record number Page number
i! I ' a . - - ' • • -. act . - D • _ I _- s 5 -
Assessed value of real property as of Mortgage sap •�• _•- near unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appOert the sole
March 1,current year March 1,• date of application legal or equitable owner?
5- br) D ❑ Yes 0 N
0 no,what is his/her exact share of interest? J If owned with someone other than spouse.indicate with whom
If nine on reed is different than that of applicant-indicate below. /FIIss..,�th��e property in question:Annually Assessed
Property ❑Annually Assessed
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Name of mortgagee contract seller
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Address of mortgagee or contract seller(number and street,ivy,state.and ZIP code)
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? (��---���r'''yyy for cement year? ❑ Yes �t"No
❑ Yes r o 11111
l COUNTY AUDROR
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.
51g re(owners firm rwneL '/^/,��/y/ • Date(month,day,year)
Full resident address of a `acan(QMt(t number and street,city,state,and ZIP code) _
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authorized by duly executed Power of AROmey 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) .