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Home My WebLink AboutMortgage_Cooper (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION / I'- State Form 43709(R13/10-15) (�,l� yn ///�� 1 (( A_ �4 Q�f1e Prescribed by Department of Local Government Finance J � INSTRUCTIONS: File Mark To be filed in person or by mail. Form Sled with: Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought Must be filed or postmarked with the County Auditor or County Recorder of the county when:the property is County Auditor boated on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder where the property is located during the twelve(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. 111'rFs-l1 c.;compact buyer- on rnrsg 1 ve side) _ v J1 1 ONei1/4 Ling, Cs cll'r isbict Key number/legal description Toxin D�� O l -1 `2 2-0‘ - O 0, - 1-1 l- - OO� R t 4 'ham Assecavl value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ tract indebtedness u id as of Is the applicant the sole ac s.c••nent date,current year assessment date,current year date of 3 / ©O (J legal or ladle owner? t 6 (\ Yes 0 No If no,what is his/her exact sham of interest? If owned with eone er O en sprints,indicate with whom ` \ If name on record is different than that of applicant,indicate belay I - in question:Annually Assessed FIT f 1.10i....-rty ❑ Annually Assessed Mobde Home(IC 6.1.1-7) Name of mortgagee or contract seller &M1 CU • MAY 2 2019 Address of mortgagee or contract seller(number and beet;dry,state,and ZIP code) ' • Name of assignee or other owner or holder of mortgage /I/ CIBSON COUNT R Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? tMiat Taxing District? Has this deduction been requested If yes,state amount of deduction other county on property for in Indiana? ❑ currentYes 0 No year? ❑Yes ❑No A person is not entitled to this deduction unless the person has a balance on the person's mortydge or contract indebtedness that is recorded in the county 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 ot. 20 0 20 20 • 20 ' 20 ° 20 5g - natare ollCaunn ry c Auditor _�J /\ County - Date(month,—�d year) I/VVe\eccehrtif\y under the ty of perjury that the above and foregoing information is true and correct and that the applicant tiis a resident of Indiana and owrpr I contract buyer of the aforementioned property on date application is filed. vS n e k nu. Date(month,day,year) Full tl nt ad of app t nu arM state,and code) % ��`� L. 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,dry,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: