HomeMy WebLinkAboutMortgage_Roberts (7)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN� Coun Township vear y
_ : FOR DEDUCTION FROM ASSESSED VAqpA� �
• State Fwm 437091R11 / 6-09) �j°i
�' � PresaibeC by DepartmeN of Lnml GovemmerR France Y
File Mark
wsraucnorus: APR 1 2 2011
To be filed in rson w b mail with the Coun Auditw or Coun Recorder of the coun where the F� �� ��
Pe Y �Y b ty property is bcated.
Fiiirrg Dates: 1) Real Property: Must file durirg the yearlw which the deduction is sq
2) Mo6iie / Manufsctured Homes rat assessed as Real P unry Auditor
6efora March 31 ofeach ��m''��t f+e dun th Are (12) months O
year Ihe deducton is hG County Remrdu
Seereversesideloradditionalinstiuctionsandnualrh'cations. GIBSONCOUNTYAUDITOR ^
II M, what
.•:L
KeYnumbu/�E�p/ ,"'/�,ao3�so�a6�.oa> Remrd�rd O^ Pag J���
l! 7(
CJ
p�operty Abnpag aCOntraa 4de6tedness unpaid as d Mortgage I Contract'vWebteEness impaid as d Is t�e appfi�ni the wM
Ma��}i1 year Eateo�avP�m�� �ega�aequNadeawne(.�
a- ❑ Yes ❑ No
emG share a 4rts¢tn rc awnea wim somew�e otlrer Can spwse. iMicate wiu, whon,
iRCm[ ttan tlW d a7V�t'ud'uate bebw. Is iM V�P�Y in Question: MnuaDy Assessed
� ❑ Real aroperty ❑ ,Mmuany assessed . . .
Name M mvtga9ee or mntract seBer
Address of rtartga9ee or mntrad s�er (nun6er end svee; riry, state, aM ZIP oode)
� °�?, 3 a�� , � �-
o��.........
Dra���er 10..�......
Card No. ..slb3............
couNn auorroR
zo _ � zo � m � so _
Counry
�
p— � p—
Date (rtmfh. daY• Y��)
��
❑ No
20 _
I/ We certify under fhe penalry of pe�ury Nat Ne above arW foregoing infortnalion is W e and correcl arM that the apD����� � a resident of Indiana arM
owner I wntrad buyer ot ihe afwemenGOned property on date appiica4on is fJed.
�awre (owne/s hEl+mrtp�� _ Date (monfi. daY Yaa�)
tlein atltlr�ss d appGCant (numDer antl sLee4 �y, state, arE LP mtle)
�►H s S� (�5 O�w�.�s�cl1�,�� N?
author¢Ed Oy E�ly ezecuted Pwrer d At[omey a by IC 61.1-12-0.7
s ot auCromcd pe�swi (numberarM sbee4 �y. sbte, antl ZIP code) ,
��