HomeMy WebLinkAboutMortgage_Robbi� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�: FOR DEDUCTION FROM ASSESSED VALUATION C T Year
� 9
�•...�+ State Fwm 43709 (R6 / 5-061
� Presaibed by Department of Loml Gwemment Finance
AN 6 2008
INSTRUCTIONS: � File Mark
To be filed in person or by mail with the County Audito� of the county where the p�operty is located. �j� ,Q�
Filing Dates: 1) Real P�operty: Du�ng the 12 months before June 11 of the year the deduction is to be e c rve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the yea�����ritl�i�li�s�t��@�e�tive.
See reverse srde for additional instrucfions and qualilications.
contracf buyer- see r+�sMc6ons,hh reverse
� axin�uistna Key number / legal desuiption Record number
� � e/ pZIG'Da.�� -�lp�o.� QQ�
Page number C
00,.3.ObS-o/ 7 � �- �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, current year March 1, current year � owne(? � Yes ❑ No
/ (v l 3 $5 °�
If no, what is his / her exact share of interest? I( owned with someone other than spouse, indicate with whom.
name on record is different ihan thaf of
of mortgagee or contrad
below:
Address of mortgagee or contrad seller (�j(mber and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, state, ZIP
Is the property in question:
O Real PropeAy ❑ Mobile Home
llra�r�cr NO...a�7 �
•....
Dces applipnt own propeRy in any other If yes, what county? What Ca rd i\'Q}.: ...7 c.i5% . �quested on
counry in lndiana? L`I� 4� d7""' ] YesO No
�PI
)eduction approved in the amount of:
20 �_ 20 �_ 20
P P
COUNTY AUDITOR
20
County Auditor
20
20
Date
20
certify under the penalty of perjury that the above and foregoing inforrnation is lrue and coRed and thal lhe applicants was / were
lent of Indiana and owner of the aforemenlioned property.on March 1, 20
SignaWre'(owners /ull name)
%
� l I
Fnill esident address of applipnt
�Y06 L SQ .S—G fi9 �
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
authorized person