HomeMy WebLinkAboutMortgage_Cochren tea'.*• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
d,. �,-.4 C1 unty Township Year
L„.. FOR DEDUCTION FROM ASSESSED VALUATION -�
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State Form 43709(R13/10-15) (ov\ ' • �b 20`OI
` ., ? Prescribed by Department of Local Government Finance eeu
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed 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 where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
• 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.
Applicant(owner or con cAuyer-spe re bictiro�aoon. verse side)
Tezdng District Key number/legal description Record number Page number
n�- ti - 26-k2 -Oci—t.O —061-i—029- 2v1 ot 4 L '9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of plicat,,on p legal or itable owner?
� .. t ooO� LX Yes El
If no,what is his/her exact share of interest? If owned with so ebne othbr than spouse,indicate with whom f 1
if name on record is different than that of applicant,indicate below: s e pr.,-.. in estiort:Annually Assessed
Real ... Afro AfroAI -ssed
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Name of m ee or contract sell
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Address of mort9gfoiNor contract seller(number and street city,s`-'--- NO V 1 5.2019
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street city,state,and ZIP code) p r a�}er O••••o••"'''•• •• ••• �N LI N TY A VD17 G R
Does applicant own property in any If yes,what county? requested w
other county Card �T O• ••••••••••••••.....•. 4 ed If yes,state amount of deduction
in Indiana? ❑Yes 0 No 1 ❑No
A person is not entitled to this deduction unless the person h _._,...,,•,,,,,6 mortgage 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 of:
20 20 20 20 • 20 ' 20' 20
Signature o j myy Auditor County l Date(month,day,year)
- 1 All\ 0,X0.1
I/We certify under the pena ,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.
Signatu (ow er's full ame) Date(month,day,yeas)
X � 4 11- \C - MCA
Full ident address of applicant(n r and street,city,state,and ZIP code)
(r-1 E DTIkirl-A - P��n, on— k4�6 .
Person authorized by duly executed Power of Attorney oriel IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZiP code)
The oenalties for cerium can include imprisonment sin to twn and a half vearc and a fins not to armed Ain nnn