HomeMy WebLinkAboutMortgage_Cochren (2) a><. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:1.-"-Neizi.pli FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R1216-14)
'�; / Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. UN Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough. 1 20 6
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ,, , , • ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o:Q/,;;•t.-"d'm!I
where the property is located during the twelve(12)months before March 31 of each year t &&S c41c (:•••l
See reverse side for additional instructions and qualifications. Y AUDITOR
Applican 9 er or • tract buyer-see :. " "'ns on ase side) /
j
T-) g pis'CI t Key number/legs esmp Record number Page number
I , G— /K/a -�� 07691461 7 /(� ( G )/
Assessed S property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract ind edness unpaid as Is the applicant the sole
March 1,an r March 1,current year date of application,/ n� El legal or equitable owner?
/`j , Yes No
If no,what is hi her exact share of interest? If owned with someone other than spouse,indicate with whom
2
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑ Annualy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller 9y /
•Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Or
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) /W' 0 .4 /
/ -o1 — / 3.6-7A2-��
Does applicant own property in any If yes,what county? What Taxi District? Has this deduction been requested If yes,state amount of deduction
other county on property for
Indiana?Inna? ❑Yes ❑No moment year? ❑Yes- ❑N"
A person is not entitled to this deduction unless the person has a balance on the person's c °I A tit (� inty
recorder's office(including any home equity line of credit that is recorded in the county tea /'l•O(_ u I�C r
COUNTY AUDITOR DA Pi-I tat
Deduction approved in the amount of:
20 20 20 20 I W - I (oI I _
Signature of County Auditor County
16,0‘e tmonm,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.
Signature(o. " .fu0 na.:,T /// Date(month,day,year)
Fu resident address of applicant(number and street,city,state,and ZIP code)
CC/( "/1/ , /7//G9c.ffNl3 .d SFr./ C-7d/l1-11n13 d /i j'/ (Al Y 7&&lib
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. Th.—_