HomeMy WebLinkAboutMortgage_Robbins (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear N
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fortn A3709 (R71 / 6-09)
�' ,.,, l Prewibea by Departmem ot Loral Govemment Fuiance
'I a
wsrRUCnoNS:
To 6e filed in person or by mail with fhe CounryAUditor or Counry Recorder o7 the munty where the property is�j� e F� �� w'��
F7ing Dates: 7) Real Pmperty: Must file during fhe year /or which the deductlon is soughG ��+� 2 v ZQ I� Counry Auditnr
2) Mo6i7e /Manufactured Hanes not essessed as Real Pruperly Must file dunng the twelve (12) months
6efore March 37 of each year the deducGOn is sought C. �J, ❑ County Recorder
See reverse side lor adtlitronal inslrucfions and quali�cations.
App5anlf�wqerormntrdUbuyer'seeresLicbonsmrever�sid�1 . �/1 A A ' COLJNTV ei�n�r.,..
-�ud-�o.s-l�) U•C
_� �� ae�������
a�M t,wm�tyrar I Ma(Ch t,�uqr
� O\
rw, whal is ha / her eraO share ot interest?
twne m remitl s Cifferent than Nat of a0P&2N. mdifate below.
Name oi rtartgagee or mntrxt seller � I
3
Add� of mortgagee or contract uuer (num�+�� uM sbeeL rdy, s�, arid
Name of assignee or oNer owner w hdder o
If
D►•a���er NO.. �0//.
.........
AAtl2ss of as9gnee (num0er antl streef, a� -
Dces appikant own ryoperty in any other Ca rd i\i Q, ,`^ �� .
munty in InOiana? • • • • . • • • • . • • . . . : . . . .
° Y� � � �as,�a9. °°
COUNTYAUDROR
D�uctlon anoroved in tlre amoura ot
20 I 20
I/ We certify under Ne penalry of
owner 1 contraG�uyer ofjGC�on
20 I 20 I 20
Remid �
iMebtetlne55 unpaiC a5 0(
spouse, irWinte wrt
Is Ne property in at
❑ Rea��aertr
Yes LI No
armuaVV nssessed
Moble Fiome fIC 67.1
Has Nis tledudion Eeen requesteC m property
fOf WrtE(ItY��� r'1 . _ rl
20 � ZO
that ihe above and foregoing in(ortnatlon is We and cortect and tha[ �he applipni is a resideni of IrWiana and
ned property on date appiicatlon is 51ed.
Date (�mN. daY• 1'aa�
�dent adtlress of e�p8rant be� a sfrcet, slate, and LP m
2o S IU 5— l�llty �� ��CV'�
auUia�d by OWy exewte0 Power o(Attm�ey w by IC 61.1-12-0.7
: of authoraed person (num0er arid strcet, ciry, sfaR, aml ZIP cotle)
DatE (manlh. daY. Y��)