HomeMy WebLinkAboutMortgage_RobbinsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS ca, v
_ FOR DEDUCTION FROM ASSESSED VALUATION
SlateFarm43709(R10H7-0B) JUN 2 2 20 9
` � Presaibed by DepaM�ent of Loral GovammeM Funrce
INSTRUCTIONS: Fle Mark
To 6e filad in persan or by ma�7 wiUr the CaurrtyAuditar o/ ti�e county whera the property is located. �a �, /�sc,
Fdirg Dates: iJ Real Pioperty: Must !8e during fhe yenr fir wNich tlre deduction is soughk � �
2) MobHe / Maiw7sctured Hwnes nof assesse0 as Real Properry: Must fde dunng tlie hveNe (12J monU(y ��Fllg�p//e� �pppR
the deductlon is sought
See �everse sitle (cr aOdRional insWd'mns andpualfications
_ ._.-._..__. _^ ____-�__
alo -o�l-�.s -yo�_ 000.s8s-o� �o0 3
Assessed value of real property as d Mortpaga / CoMad rtdabletlress unpaid as of MMpape / Cmivxq indeMeEness unFeid as d Is iha apqiraM Uie sde
Mart�h i. au�ent yea Mafch 1, wnerd year dafe o( appl�tion legal n eQUitable owneR
D O O D ❑ Yes ❑ No
H ro. whaf q ho / Aer erad shara d iNerest7 H ownad Wh sortreone other Uun spouse. "vdFate rilh Wnn
r rama on iernt7 ¢ c�em �han u�al w aavrcan+, inaimte bewuc b the a�M � a��: nmua�N rwsesme
� ❑ Real Property Q Mnualy Assessed
.. Mohile Fbme (IC 61.1-i
Address d mo�gagee or canraa
Name N assipnee or Wha ownar a Mder d mdiBaBa
naa� a�� ��mea� aa sa�. �: smm, a�e vP aoe��
:�
Na
oea�uuior� ew�'m N ma amaan d:
Z0� � 20 � 20
af Counly Audila
couNn nuwrc. _
20
Dra�ti�cr i\i0...� .
Card NO. ... �.3\°1.
'�i ( 01� la C50. bb ........ .
� � �_
Date (rtmN. daY• Y�I
20 _
I/ We cer�y und penalty of perjury Me above and faregang e�(ortnation is true antl oorred antl Ihat the applicant is a resident of Indiana arb
owna / mntrad yer of the aforanentio qopeAy on date aDV��n is filed.
S.
moW, cilY, s7aM,ane
parson (nun6rrand 5heet, dty, stafe, and LP Code)