HomeMy WebLinkAboutMortgage_Cook (6) 9 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
LI FOR DEDUCTION FROM ASSESSED VALUATION
�.? State Fonn 43709(R13/10-15)
� - Ptescrtbed by Department of Local Government Finance jr�
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INSTRUCTIONS:
To be filed in person or by mail. W.orm ;
Filing Dates- 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought .4 Must be filed or postmarked with the County Auditor or County Recorder of the county when the properly ig/0v .4 u A Roc
located on or before January 5 of the immediately succeeding calendar year. I
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Au ' of the my El Cou corder
where the property is located during the twelve(12)months before March 31 of each year the l.',
lo
See reverse side for additional instructions and qualifications. 41 n
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Were( ! Record numbir"/j, Page number
G - � /a � - oao. 5��2-00� aof � ys
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of i Is the applkard the sole
assessment date,current year assessment dale,current year date of application / legal or equimble owner?
/0�J(p� ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned vrith someone other than spouse,indicate with whom
tf nacre on record is clement than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Hama of mortgagee or contract seller
d?Q141 u.
Address of mortgagee or contract seller(number and street city,state,and ZIP code) -
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Name of assignee or other owner or holder of mortgage a O Li _CI C r.7I •
Address of assignee(number and street city,state,and ZIP code) o` C. (' L. -
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Does applicant own property in any If yes,what county? hat Taxmng District? Has this der
other county on
Indiana? Yes ❑No cnent r ❑Yes. UNo 1
A person is not enbfed to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the=any
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Dale(month,day,year)
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I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
n Signature(• ..-- (r. e) Date(month,day,year)
i.— I�w..._ �-,/ i
1 - F i -'.•= address of a t(num.-=end street thy.state.and ZIP code) ) 417&‘Q
11518 E. i-on S. 6K coy" C)
Person authorized by duty weaned 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$10,000. - - - -