HomeMy WebLinkAboutMortgage_Robling"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 shi Ye
_. • FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
� y�. PrrsaiOeE CY DepartmeN of Lotal Govemment FiIlBnte
� n�rt8 L lU
wsrnucnoNS:
Fartn hled with:
To be filed in person w by mail with the CounryAuditor or Counry Recorder o/ the county wheie the property is located. �-, �
Fiting Dates: 1) Real Property: Must ble durirrg the year fo� which fhe deduction is sought �� di��
2J Mobde / Manulactured Homes not assessed as Real Properly Must file during the twelve (12J months I�l
betore March 31 ofeach year Ne deducfion is saght GIB ON G�U�4�i^�4
See reverse side (or adtlitionaf insLuctions aqd qualifications.
T- ol � KeynumEerll tl tnn
'� ��
A.� �2hie of real a of Mpr�pap e/ Cantraa ir
Ma�d� t. a�rt year Mard� 1. wrtent year
il no, what a his / her exact share af intrlest?
tt narne m reootd'o EiRer�t ihan that ol app0�an4 I�inte bebw:
m contract
mortgagce v
streeG �% sfate. a(d
Name W assi�ea n aU�u ormer m hdAU M mortgage
Aeernss af azdcym (mmmer arM stree4 �Y. stefe. and
� . .. __'..'" _—IJFYPS.what�
' h�o�csu�, K� c3�,��y,�
1 � �K./'rHG�-
ac�io- L5a.3 .-
Syrunue af Camry Auortnr
-�/. 02./�%-D�
iass unpaid as d Mortgage / Contr�
date of appGCatio
If awned wiN someo�re oth
COUNTYAUDROR
20_ 2�_
Counry
Retord number P e numbrl
O / O ��0?�3
ss unpak as of Is Ihe eCd�nt Ihe sde
legal n WN�de aw�
❑ Yes ❑ No
:.uWica withuirom
DroPeRY in QueStiOn: Mnua�y Assessed
�I PrUperty ❑ Amlually Assessed
stea m P��Y
Yes ❑ No
20
Date (mWh. daY. Y��
�
I/ We certify under fhe penalty o( perjury that the above arW (oregoing infortnalion is We and cortect arW that the appliran[ is a residenl of IMiana and
owner I contract buyer of the aforememioned property on date ap��cation is filed.
� SlpfuL�re (ownefs � rtre� ' Date (monfi. daY. Y'��
I �
I ' ent ot appGran� (num6era sbee4 �; �ta. and ZfP oode)
% .� A� s o e�� ^ Ll
Pelson auNO�d Ey duy esw�ed Pwier al Amormy w by IC 61.1-12-0.7 i Date (montl+, daY. X'e�
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