HomeMy WebLinkAboutMortgage_Robbins�^;�„ STATEMENT OF MORTGAGE OR
;►_... ! FOR DEDUCTION FROM ASSES:
�State Fwm a3709 (R71 / 6-09)
,�� ��+ Presvi�ed by �epartment ot Local Govemment Finano.
INSTRUCTIONS: OCT O 9 LO�Z
To be (led in person or by mail. �
Filing Dates: 7) Real Property: Musi ba comple�ed and dated in the calendar yearLlor'p' ' d cfion is sought.
Must be filed with the County Auditor or Counry Recorder ol fhe county whe e p erty is located
on or before January 5 ollhe immediafely succeeding calendar year.
2)Mo6ile/ManufaciuredHomasnotassessedasRealPropgGybQdy„jf(a,�yjfp,fqq. �o�olthe
county where the pmperty is locafed dunrg fhe twelve (72rtN6rilXsbeYdia Aiarch o eac year �he
deduction is sought.
File Mark
Fortn (led vnih:
�CounryAuditor
Counry Recorder
See reverse side lor addifional insirucfions and qualifications.
Apqiwnl (awner w convact buyer - see iesfnctions on reverse side)
Marty W Robbins
Taving Dis:rid Key number / legal descnptlon Recad=umEer � Page number
Center 2G7 3-20. 7 03-00 7.176-004/Lts18,79,22&23CollinsAddit jov
Acsessed raWe of real poperty as W Mortgage / Con:ract inOeOtetlness unpaid as of Mortgaga / Contrad indebledness unpaiE as ol Is Ne applicani Ne sde
Marth 1, numnyear Marcli 1, wrtent year Oate ot apptica;ion legal or equitahle wmerl
152093.00 ❑� Yes ❑ No
If fro. what is his / �er exaa share o( in:erest7 If avned with someone oNer Wn spouse. intlicate wiN xTOm
If nama on record is CiBerent Nan Iha� o/ appliwnt, i(bicate Cebw. Is the property in questlon: MnuallyASSessed
. 0 Real Property ❑ Mnually Pssessed
MoMle Home QC 61.1-7)
Name of monga9ee or mnvact seller
German Ameriwn Bank
Address of mMgagee or mnvact se0er (number arM stmef, cdy, sfate. arM ZIP code)
�, PO Box 360 Jasper IN 47547-0360
Name of assynre w ather owner or holder ol rtrort9age
AOCress of assgnea (num6er anC sueet, dry, slate. and ZIP code)
Ooes apd��nt own D�OenY �� any oNer If yes, what counry7 VJhat Tazing Distrid? Has Uis deduction been requested on property
counry in bMiana? ❑ O No fw cunent year7 � yes ❑ No
Yes
20
artaunt of:
20
COl1NTY AUDITOR
20 20 20
20 20
Date (monN, day. yea�
I I We certify under the penalty ol pe�ury Nat Ne above and foregoing infortnation is We and corteci and that the applirant is a resident of IMiana antl
owner I contract buyer of the aforementloned property on date application is filed.
�i�, G" ' ��'—_
Fvll resident adtlress ot applirant (number and sbeei, city, stafa, antl ZIPm
1884 S Collins St Francisco, IN 47649
Person auNwaed by Euty ezeated Power ol Attwney or by IC 67.1-12-07
person (number antl sbeef. ary, stafe.
tlay. yea�
09/26/12
yea�