HomeMy WebLinkAboutMortgage_Robb (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
� FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-09)
,' � PresvibeE by �epartmenl af Local Govemmenl F�ance
INSTRUCTIONS:
To 6e tled in person or by mail wiN the County Auditor or Counry Recnrder o/ Ne counry where the pioperty is locat :
Filirg Dates: 7) Real Properfy Must file durirg the year for which the deduction is mught.
2) Mobde / Manufactured Homes rrot assessed as Real Properly Must h7e dunng the hveNe (12J monfhs
6efore Ma/ch 31 0/ each year Ihe deduction is sought.
See feverse side 7or additional insLuctlons and qualihcafaons.
uwau ney � nue� i xyni
-ao� oa 3. �
Assessed value d rnvl property of age/ Contract iMehtedness unpaiE as ot Mw
Mard� 7, amnt year Ma 1. wrtent yeer datE
Ii ro. what ts his I her erxY �are ot interesl? - If owned vri�
If name on 2wN is Eitfereni than Ihat of aPW�'ani, 6qipte Debw.
xtgagee or contrarl se0er �S /
l� (1 1
C_ `!.T
nmtgagee or mntract se�er (numhu and sL
signee a oNer owner or hdder W mongage
dry, srare, s�d zia mde7
AdGress ot assignea (n mb aM sde�4 �: sfeEe, eM ZIP ootle)
Does epplicant own yoperty in any oNer �� t
munly in Ird'ana?
❑ Yes ❑ No
oed�c0ori evwwae � me amwk oe
2� 20 20
N�n OC�un�4iditor
lr"i
�__� County Remrder
. �� � Recurtl number � numbg
/ Contract'uMebteCnrss unpaW a d Is Ne eppfivnt Na sde
legal w itade awnel7
� � Yes ❑ No
x�e othrl than spouse. IMkste with xiwm
�Is e property in Question: MnuaOy Assessed
Real Roperty ❑ Armua�y.4ssessed
\ bbdle i-lart�e fIC 61.1-i
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� �3R aDO� 6° zo
� I —
en requested m property
❑ Yes ❑ No
20
SgnaMe W Camry Aueilor I Caunry I Date (month. tlaY• Y��)
1/ We cerb(y urdu the penatty of perjury that Ihe above and foregoing in(ormalion is W e and cortect arM Nat the applinnt is a resident of IrWiana aM
owner / contracl buyer of the afixemenUoned property on date applirdtion is filed.
Sipre� (owne/s h� rame) ^ q� � 1 /(rtpntA. daY. Y�h
.�'� . . _ �i/..r ri�
or
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Person autlw�rzed Ey tluy executed Pawer o(lUtomey or by IC 61.1-12-0.7 ' I Date (rtronN, day, yEa�
lddress of autlmr'ved person (number aM sbee; �y, uafe, and ZIP code) .