HomeMy WebLinkAboutMortgage_Robinson (13)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS �
� FOR DEDUCTION FROM ASSESSED VALUATION o n w hip Year
's � � State Fwm 43709 (RS / 4-03) J
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� Prescnbed by Department of Local Govemment Finance ►1 O II � �oo `
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INSTRUCTIONS: � ile M
To be filed in person or by mail with the County Auditor of the county where the property is 1 t�SON COU Ty qUDITOR
Filing Dates: 1) Real Property: During the 12 months before May il o/the year the deduction is to be e/fective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. '
Applicant (owner or co tra t 6u er - see restndions �vers side)
1 '
Taxing Distrid Key number / legal description Re r number O�— �
�� � Page number
1 OI�-o'�ilb -�a
Assessed value oi real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year ownef? �s ❑ No
-1 S Uoo
if no, what is his / her exact share of inierest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is th property in question:
�eal Property � Mobile Home pC Gt.1-�
�e of mort agee or contract seller
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Address of mortgagee or contrad seller (number and et, city, stale, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? propeAy for current year? C] Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 � 20 �� 20 � 20 0 q 20 20 20
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Signature County Auditor Date
We certify under ihe penalty of peryury that the above and foregoing information is lrue and corred and ihat the applicants was / were
.esident of Indiana and owner of the aforementioned properiy on March 1, 20
' ature ers f II name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F esi ent address of applicant Address of authorized person