HomeMy WebLinkAboutMortgage_Robinson (4).e,:
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
ti ! State Form 43I09 (R5 / 4-03)
� PreSCnGeu by Departrront a1 Lacel Govemment Financa
Coun Townshi Year
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INSTRUCTIONS: File�'�J,a
To 6e filed in person or by mail witA the County Auditor o/ the county where the propeRy is located. A� � � � L��6
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the deduciion is to 6e el/ective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/ the year the deductiomisdo be eHective.
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See reverse side for additional instructions and qualifrcations. � �
GIBSON COUNTV AUDITOR
buyer-
Taxing Di 'd
(.�,{'�
Assessed value ot real property as of
March 1, current year
If ao, what is his / her exad share of interesl?
If name on record is different than that of a�
mortgagee or contract seller �
Key number / legal description Record number ,ry'
�l�o �d • /�-30aj •oQ,i.07o0J•8 �J�O
o � g-v aa � o'�� Page number �^ py
•i a
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year ownef! ❑ Yes ❑ No
l��...n (�3,00�
owned wifh someone other than spouse, indicate with whom.
�, n � Is the property
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���z-oon ,$1r.
Address of mortgagee or conhact seller (m �oo /_ ���mQ ��
(0 578'4 7/a�
Name of assignee or other owner or holder ot mo� �yay„ ��O 3� OOQ , o 0
Address of assignee (num6er and street, city, state, ZIP code)
Does appliwnt own property in any other � If yes. what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �_ 20 20 � 20 20
P T /
Signature County Auditor
We certify i
esident of I
nature
1 r ident a�
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❑ Real Propety ❑ Mobile Home (IC fr1. t
Has this dedudion
property for wrrent
20
20
iested on
Yes ❑ No
the penalty of peryury that the above and foregoing information is true and corred and lhat fhe applicants was / were
a and owne� of-ttrg aforementioned property on March 1, 20
full name)/
; /
M �
ss of appticant _ �
Person authorized by
or by IC 6-1.1-12-.07
Address of
executed Power oi Attomey
person