HomeMy WebLinkAboutMortgage_Robison'°* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:__ .; FOR DEDUCTION FROM ASSESSED VALUATION �
Siata Fortn A3709 (R71 / 6-09)
� PresaiEeE M�Da�rd o( Laal Govamrtiem Fl�mrce �
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To be filed in person or by mail with the County Auditor or Counry Recorder ol the county where the pioperty is located. F�"'�me� �
Fffing Dates: 1) Real Property: MuSf file durirg the year /or which the deduction is sought. unry Auditor
2) Mobde / Manufactured Homes rat assessed az Real Property Must file dunrg the fwelve (12J months �
befae March 37 0/ each year the deduction is swght. nry Recorder
Seereverseside/or�dd'Rionalinstredbnsendquelificafioyc� _ . r.iocnu rnnuTV ei:nlTl1R
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MarU t, arrent year
tt ro, what fs his / tcer e�d share o( Nteresc?
fwre m remtl e Ntferent man that of appOCant
rlame m rtnrtyagee «
rtiafga9ce u mntraa
owner w haldm M rtartgage
�Y. sm�.
AdCress ol amgnm (mmIDer ertl sdeeL tlly, s�. eM ZIP co0e)
Dra�ver NO...c�OJ.Q........
( Card NO. . �1�pp.Jr............
I4-' ..`AO1���.ioy
9� '�rr,.�-Qq. Ro�.00n
I I We cerOfy under ihe pena�perjury that the
owner I can4acl buyer of ihe mentioned prol
mae�re (ownerS hA neme)
resitlen[
by duy ezewtetl Power a(AUaney a by
auMa"vea pnison
- Ob �•�o l�- Da% p�0 / 0 r��p� ��
mPaid as N Mortgage / ContraG in0ebtetlness unPaid as d I5 Ne eOW�t Ne sde
date af appGcstion legal ar edultade ame(1
❑ Yes ❑ No
H owneC with sort�eone othel than spouse, uMicate WM whdn
�e WoVertY in Ouesicn: MmieOy AtsesseE
Real PrOPenY ❑ ���Y �
Hi:l3I T21.1(IJ �6iflfli �iM I�16 �Um011 b0GI1lGjUGSIGd CIl pfOpPlff
for artent Year ❑ Yes ❑
GOUN7Y AUDROR
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i r���hrv�- v�—i �- i�,
faregoing infortnation is We and mrrect arM Mat Ne applirant is a resident of Indiana aM
�.e aD����tion is filed.
oa� ��m. aar. rgen
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Date (manfi. OaY. Y��