HomeMy WebLinkAboutMortgage_Robinson (5)�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�v�,. -J Slate Fwm 43709 (R6I5-06)
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Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS: Fi_�e lJla�
To 6e Cled in person o� 6y mail with lhe County Auditor ol the county where the propeRy is locate� �� ��
Filing Dafes: 1) Real Property: Dunng the 12 months 6elore June Il of the year the deduction is to be effective 1
2) Mobile Homes assessed unde� IC 6-1.1J: Between January 15 and Maroh 2 of fhe year�tb�Vd u tl n is fo be e8ective.
See �everse side fo� additional inst�uctions and qualifrcations.
� � �1007
(owne� or
Taxing Distrid
ASsBssed value of real property as of
March 1, current year
If no, what is his / her exact share of intere,t?
Key numbe� / legal description
GIBSOtd
number
n� _� � T�_ � — e number �/� r
�� Orii l0 5
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equita
March 1, current year owner? ❑ Yes ❑ No
53ooc�
If owned with someone other than spouse, indicate with whom.
If name on record is diBerent than that of applicant, indicate below:
�me of mortgagee or conVact seller �/��v n n, �
i� .(\ //
I�C�L�Ci Y`
Address of moAgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder ot mortgage
(number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? I What Taxing Distrid?
county in Indiana?
Deduction approved in the amount c\ a�Q � p�� !�
llC�\tlCl' \�......
20 _ V 1 I 20
�
Signature
in.e W �_ �S�i�`7w O�
County Auditor
❑ Real Property ❑ Mobile Horrie (IC Cr1.1-
Has this dedudion
property for current
20
20
iestetl on
Yes❑ No
' We ceAify under the penalty of perjury that the above and toregoing information is true and corred and that the applicanls was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners /ull name)
resident address ot
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person