HomeMy WebLinkAboutMortgage_Robison"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__,. : FOR DEDUCTION FROM ASSESSED VALUATION
� S�ate Fortn 63709 (R71 / 6-09)
�' ,,,� f PresaibeO Ey �epartment of Local Govemment Fi�nce
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INSTRUCTIONS:
Fortn f�ed with:
To be fiied in person or by mail with the CounryAUditor or Counry Recorder of the counry where the property is located. � �n ��
F7irg Dates: i) Real PropeRy: Must file during the year tor which the deduction is soughG C T � Auditnr
2) Mo6de / ManufacNred Homes not assessed as Real Pmperty.� Must file dunrg the tweHe (72J months
6efore March 37 0l each year the deduction rs sayht. .�, R���
See reverse side lor additional instrucfions and quali�cations.
App5°`n(°wne�Olp°"tra° "a`'see`esfi`'dw",y�`e"E`sesl°e) /i _ GIBSON COUNTY
Ta "ng �istrict Key rvanCer / legai desaiplion
- - - -D��
d vahie dmal piops;y as of Abrt9age/ Contrau iMeOted�ress i
'Marm t. amnt f� Marrh i. cv m �„!y
U�
It no. what is his I twi eraa shara or interest?
tt�rtn m �emrA s drtferent fhan that o( a0p6caN. citlirate Celovr.
Name of rtnrtgagee a mnuaG se4er ( /
JI
Pddrea W �mtgagre w mntraa srAer (num6er end sLae4-�1: state. eM LP cede)
3
Mwt9a9e / Contrari irdehtedness unPaid as d Is Ne ePP��I lhe sok
Cate of application legal or epuitade wrtreYl
❑ Yes ❑ No
It owned wiN somewie dhellhan spouu. iMxate with whom
Name ol assignee w oNer owner or twlder d matgage . �
AdCress of assignee (num6er arN street �; sw. .5 � � �" "r ��
ooes app�v o,m pracenY m e�y m
oounry m InOiana?
❑ Yes
Deductian appoued in tlre amounl aE
�
Sigiutlire d Counb Autlitnr
I I � �3a�
�# �3,5�� i
20 — � 20 � 20 —
Caunry
20
Is ihe property in QuesOOn: MnuaOy h1sessed
❑ Real PmPeKY � A^^�Y�
for au�ent ynaR
20 _
:teU m P�openY
Yes ❑ No
Date (montA. daY. Yu�
20 _
1/ We certliy under Ne penalry ot perjury that Ne above and toregoing infortnalion is W e and cortect arW that ihe applipnt is a resident ot indiana arM
owner I contrad buyer of the aforememioned property an date application is filed.
I�Sowrrer9lutlname) „ n � Date(nmfi.daY.Yge�
aM
au0rof¢ed Ey duty executed Power o( Atlomey or Ey IG61.1-12-0.�
: of auNOr'¢Ed person (number arM sbeet city. state, and ZIP code)
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