HomeMy WebLinkAboutMortgage_Cox (24) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION F I L
L;'J State Form 43709(R11/6-09)
Prescribed by Department of Local Government France
File Mark
INSTRUCTIONS: •'^`n r••A
Form fi)9d-Wllh:a ZV IY
b be filed in person or by marl 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 County Audi
2)Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months r�/�• ry- er
before March 31 of each year the deductions sought `1.. !mtY.}f�n..�d
See reverse side for additional instructions and qualifications.
G.C .,.,. O3::::": ;..2:: R
Appfram(owner or contrar" -�varsq.Aiie) (rte h
Taxing Distill Kel/num6er/�t aesa�ipition Record number Page number
t�,RAt-J a�- - 23 3oa— daa. 3r-nI a DI `f ac. `f9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Ip�M'ortgage/Contract indebtedness unpaid as of Is the epplcont the sole
March Lament year Marta ,ane^ntlyear I date of appll tzm legal or equRaNe wmerr
S L T lot • 4Pes ❑ No
If no,what Is Ns/her exact share of interest? If owned with someone other than spouse,indicate with whom
is different name on record ierent than that of applicant,Indicate below. Ill the property in question:Annually Assessed
- rimy°_',Property ❑AsmimflyAsse
_ Mobile Home(IC 6-1.1-7)
of mortgagee or contract seller 4 J 7,k l g O0 -
Address of ee or contract seller(number and street,coy state,and ZIP code. Di- .
, C) NO. 02
Name of assignee or other owner or holder of mortgage �•''••..
Car() NO' 02(94/
Address of assignee(number and street,aN,state,and ZIP code) /'1 (�]''`
Does apples own property in any other If yes,what county? • •Ty(\nK.V tested on ply
❑ Yes WM° I j 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 hue and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is Red. .
`Snignabue(owner's MI MI name)/1 /� / Date(month,day,year)
ullIb C..1. v-i r I r l.nc ` 4
F resident address of applicant(number and street,at%slat ,end ZIP code)
° 31011L-1 n1• 2asWest PcztAkaa , IN 'I 761/ 6
Person authorized by duty 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) .