HomeMy WebLinkAboutMortgage_Robinson (9)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,_ � FOR DEDUCTION FROM ASSESSED VALUATION
. :• State Fortn 43709 (R71 / 6-09)
�' ,,,, � Presaibed by DeO��M of Local Govemrtrem Fuance
II
INSTRUCTIONS: F
To be filed in person or by mail with the CountyAUditor oi Counry RecoNer o/ Ne county where the propeRy is located. � U (�
Filing Dates: 1� Real PmpeAy: Must file dunng the }rear for which the deduc0on is soughL Counry Auditnr
2) Mo6de / Manufactumd Homes not assessed as Real PrUperty: Musf fife dunng Ihe twelve (12) months C �
6efore March 37 of each year the deduclion is sou7ht. unty Recorder
See reverse side for additronal instructions and qualifications.
Appfimy�(ownerarcontrertbuy�er-see mr€versesitle) .
Tapriq oiso-ia - Key numter�ieyai desaiotirn ^ QO _ 0 D D• SO `8— O� / Re`°'d numner raye,n� 7�
!o - 17-09 I �0 3
A,� d real a d Mwkwge / Contraa'c�btetlness unpaitl as of Mwtgege I Conva�Y mtlehted�ress unpaid as d Is Ne eppfmant the sole
MmU 1. year Mardi 7. airtent year Eata o( a0 �^ legal w equitable wmdt
� 9Q0 ❑Yes ❑No
If no, what ¢ his / her e�cl share ot intemst? If ormed wiM someo�re oNer ihan spouse, indrare wfih whom
If name on remtl iv QAterent than Nat ol aPP�nt, i�Minte Cebw I5 tl�e propeM1y m QuesUOn: Mmially Assessed
���Y ❑.��..�.a�����n
Name of rtprtBa9ee a mntract se�er �/�
�
Pdtlress of mortgagce w wntraa seAer (num6er and sbeet �y. sta+e. aM ZIP cade)
tJame W asvgnee w oNg owner or holtler of mortgage
AdEress of � ce(nu i aM stree4 a1y. state, and Z/P code)
� cJ -3- ,b�� ��
Does applksnt ovm pmperty in any olher I( yes, what munry/? What Tavrg D'atri�
munry in Intlena? ❑ No
❑ Yes
COUNTYAUDROR
Deduction aPWovad in Ihe amount of:
zo _ zo _ zo _ zo _ :
� � ���� «� o�
�,9���
ll,-�,�.�,� �.�o...ao�� _
..
ca�-� ���o. .....357s -
»mre� c«a,�a,ea«�^ n��'^' I ��N
/�
I/ We certi(y under ihe pena�ry ot pe�ry that the a�ve and foregning infortnation is W e and cortect and that ihe
owner / wnVact buyer of the aforementioned prop nn date appliption is filed. "
f appfmani (numbe�and sbeef, dty, state, and LP ootle)
���. .�c� i � � d l,.Je.
luly execuled Power af A¢omeY m Cy IC G7.1-12-0.7
person (num6ei aM sbee; ciry, 5late, and ZIP oode)