HomeMy WebLinkAboutMortgage_Roberts (2).r�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�, .,. FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R8/ 2-07) �
�°�; •� Presaibed by Department of Local Govemment Finance
File Mark
INSTRUCTIONS: APR 0 3 Z��9
To 6e fled in person or by mad wifh the CountyAuditor oJ the county where the propeRy is located. �
F�ing Dafes: 1) Real Property: During the 12 monfhs be/we Juna 11 0! the year the deduction is fo be e/fecGve.
2) Mobile Homes assessed under IC 6-7J-7: Befween January 15 and March 2 o/the year Ure deduet�,is to b�ljyctive.
See reverse side /w additional insWctions and quali(cations. O��a� /Je�
m
number / legal
Assessad ralue of mal poperiy as d MarU 1
whal is his / her enaG share of
nameon
Q V
year Mortpage / Contraq inde6tedness unpaitl as ot March 1,
wRent year 't� . I�)
V
Name ot mortgagee or conUaa se�ier �(� �� '
� �.
Address ot mortgagee a canirad seller (num6er aM sfinef, aty, sFete. and ZIP code) .
Name of assignee a other owner w hdder of mMgage �
Address at asvg�e (n�nnber a�M s7eet dN. �ste. eM 2 �O ±. _�-.� � A N G_— �
(F �1 U i
Ooes appliwnt o.m praperty in any olher If /�
wunry in Indana? D y_/�//,�
❑Yes ❑ No � �y
Deduction approved in the amount of:
20 �
SignaWre of
I/ a
20_ � 20_ � 20_ � 20_
Record
IsNe
spouu,
w equ�taae owner
❑Yes ❑No
Is the aWeKY in vuestion:
❑ Real Hoperty � Mobile Home QC 61.
❑Yes ❑ No
20
Date (manfA, day yea�
20
under the penalry oi perjury that the above and foregoing information is We and cortect and Uiat the applicanfs was I were a resident of
�wner of the atoremeoG3ied�roDeAV on March 1. 20 .
abylC
of auitnr¢ed persm (number and stree4 aty. state.
�a1e (monN, tlay, yea�
Dale (rtm(A. daY. Y��