HomeMy WebLinkAboutMortgage_Robinson^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
= FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R77 / 6-09)
, P Ptesvibetl by Department af Loml Govemment Fnance .
Fil M
INSTRUCTIONS:
Fortn Ned wBh:
To be filed in person or 6y mail wiN the CountyAuditor w County Recorder of the county whera the pioperty is located. (�Q
Fi!'mg Dates: 7) Real Pmperty: Must file durirg Ne year for which the detluction is soughG D�����(yy��
2) Mo6ife /Manulactured Homes rat assessed as Real Property: Must file dunng the fweAre (12) months ❑
before Ma�ch 31 of each year tha deducfion is sought Counry Recorder
See reverse side Ior additronal insWC�ons and qualficafions. '�' �
InPpbc�t(owxrucono-arlbuyer-see mreversesiee) � GIBSONCOUNTYAUDITOR
numEer / legal des
l� -io_
AsesuO rdlue d real piopgty az of
M3rch 1, airent ypt
11 m. what is his I her erxt share of internst?
artent
If name on �emN is dtlferent than that o( aOP�x �dirate Oebw
emN
.ra�uY-:i
rtprtgaqee ot wntraG se0er
Name ol assignee w oihel wmer or hdder of rtqryage
Record numher Pa e numbu
- oa - Ooo• 8� 7-o �S aoa9 � 3 8 9
'uWe6teCness unpaid az W Mortgage / ContrarY mtlehtedness unpaid a d Is Ne appfcant Me sole
v tlate of appGCatirn legal w equitade owna(7
r� � n ❑ Yes ❑ No
cey; stam, aM LP code)
Address of assignee (number aM stme4 �'+ry, stete. enC Z�P code)
Ooe58Pplitantovm property
�wmri��ndana� �
H wmeE wiN someorre other than spouse. Udi�ata with whom
perty in a���: /+^nuaM dssessed
ProPeAY ❑NmuallyPsse55ed
bbbBe Flome fIC 6
VJhaf 7a' �. ...-•^ � Nas N5 detlut]ion Ecen requeste0 m properry
' '".—...r wa(! �
n ��
COUNTYAUDff( D1�11Yei' i\'0..., aOU / —
GuctionaPP�'�iniheamountot •••••••••�....
Card 1�'O. ..5,4,�.1......
20 20 20 20 _
��aWreol bAUditor n Counry � lo�� O�/�. '7lJ .•
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I/ We certify under ihe alty of perjury that Ihe a ve antl (oregoing infortnation is We and corteC ar�d ihat the applirant is a resideni of Indiana and
owner I contraa buyer o Ne aforementioned pro on date apP���n is filed.
»Wl�io�meh hA rame) /7 n. Date (rtmfh, d3Y. Y��
Ftill resiEenl adCress ol appGCant (num0e� and stree4 �Y, �le, and ZIP ootla)
6/�3 S/,�5 w 6f%��.4�� /-� zr
Pason auNO�rzed Ey duly executed Power of Attorney or by IC 61.1-12�.7
Pdtlr� oi autM'¢cW prlson (numDer a�d sbee; ciry. state, aM LPCOde)
Date (nronN. d2Y. Y��
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