HomeMy WebLinkAboutMortgage_Rothrock (4)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 03709 (R812-07)
S.•�. ! Resmbed by Depanment W Local Go�emment Firence
ile a
INSTRUCTIONS: .
To be filed in person or by mad wrth Me CountyAuditor o/ lhe courtty where the p/operfy is bcated.
Fd'a'g Dates: 1 J Real Property: During the 12 months be/ore June 11 d the year the deduction is fo be eRettive. �� �(j Q� 2009
2) Mobi7e Hames assessed undei IC 61.1-7: Behveen January 15 and March 2 0) the year fhe deduction is to be eA'�Ve
See reverse side faraddilional insWCtions and quali(ICatans. �
n , °/�(�-
Appiicam(amer byer-see ��i verseside) (f V.��MO � �I
aweb �
� I( ro, :.nal is his I her exacl share W interest?
1 If rpme on recwd is diRerenl Ihan Ihal
� Nartre of mortgagee or
�n-ol-(0�-001 _9ia
ye i comraa c,a�a�s ��a as ur e.�arc,, �.
'�°�` sa so
�rwmedwiu, som=^^^-"__..-
�w
mongagee « wntraa sdle. (iwmars ano street aN. siale. ara
of assi9rree or alhe+ u.'�e+ar hdder of mortgage
Address oi assignee (mrtMer eM s4eet. city.
Does aPpliraM wm propertY in arry dher
counry m indiare?
❑ Yes ❑ No
Deduction approved in Ure amwnt of:
2b
Sy rao dM1
I/ We certify nder Ih alty of pei
'anaand aof aforementic
ers/Wlnartre)
i
u0 re � t a ress of applicaM (num6er ar
Person aulha'sed by duy exeated Powa o
AtldressafaWnr¢edpersan (num6araMt
If yes. what caunly!
20
What Tadng Distticl':
COUNTY AUDfTOR
20 20
the above and foregoing infw
�erty on Marth 1. 20
stafe,
aty, state, arM LP mde)
W e and corr�
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