HomeMy WebLinkAboutMortgage_Robinson (11)i?� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' = FOR DEDUCTION FROM ASSESSED VALUATION -:. Year
w� ! State Fwm 43709 (R61546)
� Presaibed by Department of Lacal Gwemment Finance
FEB � ° 2008
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before June I f of the year the deduction is to be eflectiv� ��'
2) Mo6ile Homes assessed unde� IC 6-1.7-7: Between January 15 and Ma�ch 2 of the��eSQN� �(�1i7)k�i26r�R1�/fective.
See reverse side for adddional instructions and qualifications.
or con6act buygr - see
Taxing
Assessed value of real property as
March 1, current year
what is his / her exad share of interest?
If name on record is different
of moAgagee or contrad
that
Address of mortgagee or contract seller
reverse side)
Key number / legal descripVoh Record number
ll a (� —j
��-14-Igj -IU oZ �00. (og(o{�p Pagenumber �� �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year owner? ❑ Yes ❑ No
If owned with someone olher lhan spouse, indicate with whom.
indicate below:
and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street,
Is the praperty in question:
�.Real Properly ❑ Mobite Home pC 61.
Dra���er NO..!.!!};SJ, 7.......
Dces applicant own property in any other If yes, what county? NR �5/ TJ equested on
counry in Indiana? CBCd NO. ....... �Q',�, ❑ Yes❑ No
Q........
#i30j�33,�
COUNTY AUDITOR
Deduction approved in the amounl of:
20
Signature
2� � I 2� 2� 2�
County Audilor
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and correct and thal lhe applicants was / were
lenl of Indiana and owner of the aforemenlioned property on March 1, 20
of
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person