HomeMy WebLinkAboutMortgage_Robicheaux"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co vear
s FOR DEDUCTION FROM ASSESSED VALUATION
�-_" ,����o� cR„ ��, D C 2 0 2011
,�,� Resaibed by �eVartmeM of Local GwemmeM Frence
C �F�,�Ie.Mark-
srRUCnoNS:
Formtaed ' :
o be filed in person of by mail with the CounryAuditor or Counry Recorder o/ the oounty where Ihe pmperty is bcated.
Fif'mg Dates: i) Real Property: Must file during the yearlor which the tleduction is sought. (;1 BSQ C�1T���T���
2J Mo6de / Manufadured Homes rat assessed as Real Pmperty: Must file dunng Me M1veNe (12) montlfS
before March 37 ot each year the deduction is sought. ❑ Counry Recorder
See reverse siCe for additional inshuctbns erM qualficafions.
acf 6uyer - se shictulu m reue+sa sde)
�- ..P1%PY M rn n
fIGTn'. l!^
If no, what is his / her ezaG share of inte`est?
It name m �ecwG ¢ diRerent Nan that o( aDpGpnt'cd'�cate bebw
Name of mortgagee m m�traU
rtortgagee or contrad se�er (num6rl ercl slreeG �N. ��e. aM LP code)
Name of assignee w other owner or hoWer N rtqrtgage
Adtlress at assignee (num6ei eM sheet tlry. ste[e, arM ZIP cotleJ
wocem
Detluction app�o�n.W in Ihe amount of:
�
sy�wa a c�,b n�,a�m.
I/ We certfij under the
20 _ � 2p
a
��
az
I( awned wiN someorre other than spouse. iMNate wRh whom
iilable ovme(.�
Yes ❑ No
Is tlie property in puestion: MnuaDy Pssessetl
�Real Property ❑ Nmually AssesSed
�O� '�
NfAD'uk ���kA
^�'kA�-,�„�—
_ II G"�/ J
�
I
COUNTYAUDROR
20 _ 20 _ 20 _
Caunry
Da�e (mon(h, daY Y��
a���y
❑ No
Ti7
ry of peryury that Ne above aM foregoing infortnalion is We and cortect afM that the appiirant is a resident of Irdiana aM
aforementioned propeM1y on date application is filed.
/� Date (rtnrrth, day, yae�
F�/ull msiCent aOEress W appfirant (num6e�antl sheef, dry, 3Eate, and
/� �Q% (� _ GO�il/lS'T s/ ,
Person
.! Pddre55 W aulhor¢ed persM (number aM 5hee; rify, stafi. end ZlPCnde)
�
Date (nronN. daY. Yae�