HomeMy WebLinkAboutMortgage_Roberts (4)� ^�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION ��
- �� Sfate Fwm 43709 (R11 /609)
�` ,W Presvibetl by Deparimen� of Loml Govemment Financa
File Mark
�INSTRUCTIONS: D �7
To be filed in permn w by mail with the CounyAuditor or Counry Recorder o( the county where the pro�rt}4 is /ocat�� � 2 Form med vriN:
Fifing Dates: i) Real P�operry: Must �le during the year for which tAe deducfion is sought. Counry AuCitor
2) Mobile /Manufactu2d Hortres rrot assessed as Real Pmperty: Mus[ file during the hveHe (Y2j�
before March 31 of each year the deduction is soughG � County Recarder
Seereversesidelaad�ifie�linstructlonsarrdqualfications.,, �� GIB$ON COUNTY Allnirna
fq.
0: V1�PJPSt�
u
If narne m �emd's 6fisent Ihan Nat of app6mnt, mdirate helaw.
Nartre of matga9ce or
Address of martgagee or contrad sn�er (nun6er eM sheet,
Nama of assignee or oNer owner or ldder of nprtgage
of a,signee (numba� erM atreeC city, siate. aM ZIP cotle)
Dces appiirant own propeity in any oMer _' D wntyt
murrtY m Ind¢ria? ' n '�`'+1^ n�
IC
��� S� M y L �o�
� o � � -�� 09
0
i
�
What Ta�ong DislriC?
20
�b
appliont 1he sole
x equitaWe ovmeYl
❑ Yes ❑ No
SpOUSE. Ifl�%2IC `M�i�1 W�IOffl
Is tM property in QueSGOn: Mm��aOyASSesseO
;] Real RoPeKY ❑ ?!?�!!�h! �
Nas Ihis tle0udion
fw artent yeaR
20
oa� (,�or,rn. aar r�A
� P�Y
❑ No
20 _
I/ We certify undei the penalry of�erjury [hat Ihe abov,� �nd foregoing infortnaUon is We and correct and that the applipnt is a resident of Indiana aM
owner I mntracl buyer of the afwementiwied property�o(i date application is filed.
�"g re(ownerS name) Date (monfi. daY. Y�h
L
Full resident atldress W ircant n r and sLee4 tity, state, ard ZIP coda)
1n �l � go �^ O���ns v� I 1�� I� �!'11e, �
�e�son auNOnzed Gy duty executetl Prnrer of Attomey or by IC 67.7-12-0.7 ' Date (monN, tlay, yea�
Pddmss of author'¢N person lnum0er aM sLeet, clry, state,