HomeMy WebLinkAboutMortgage_Romershausen°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �' �
� State Fam A3709 (RB / 2-07)
�' � Presmbed by Department of Local GoremmeM Finance
NM
�NSrnucnoNS: APH ���5�9
To be filed in person w 6y mad with the Cou�rtyAuditor o/ the couMy whe/e the properly is located.
Fding Dafes: i) Real Hvperty: Dunng the 12 rtronMs be/we June it o/ the year the deduction is to be e7fective.
2) Mobile Hames assessed under fC 61.1-7: Belween January 15 and March 2 of Me year the deductim is�Tg�e�2(
Seereverseside%raddtionalrnsWcbonsamdqualificafions. OIBSON COUNTY AUpITOR
AooFaaM (owner or conVad buYai' A4e restriiions m ryverse side)
T�rg DisUid Key number! Iegai Eeuription
ab-/8-3 �-�/o a-000.0271-00
���oF�,�,�ffia��,,.�,�� �����,����������,,.
a� �
8 5oa6
If m_ whal is his / ha e.xacl share of inte2sl? If ownetl with sortiema oll
If rame m
mor�gagea or mnwa��
� ,
or mongagee «mnOSa seller
Name of asagnee n Wier owner w
�«
Doe$appY
couMy in Ir
�
Deduction
20 _
SgraWre i
opaNy in mry olher
❑Y�
��,�of
iMimfe bdow:
3ree( dry. sFafe. and LP code)
�n: ��a. ���r�e,
�f yas, wnz
VJhat Ta
�s
a ��a ��
�Yes ❑No
spwse.'uWicate vrith whom
,Iis N�e praperty in question:
�7teal PmpeAy ❑ Modle Home
�j(�1��5++�'US���
�E� ��
0�-8��
Zp _ I pp I 20 _ I 20 _� I 20
oate (rrmfh.
M�
� ❑ No
20
I/ We certify under the penalty of perjury ihat ihe above and foregang infomiaGOn is true and correU and ihal the appGpnts was / were a resident of
Indiana and owner of fhe atwementioned property on March 1, ZO
i (owners rw� neme) oa�e �mmm, der. r�o
� . _1l i/ _t./ � _ _ . . Q . �/— 7— r) 9
nnber street dY, sfafe. a�d LP aotlef_
,�,�s�� i 1i 4 7� 3
power oFPdirnrrey ar by IC 61.1-12-.07
of aulha¢ed persan (num6er aM street rity, sfafe. arM ZIP oo�e)
,��