HomeMy WebLinkAboutMortgage_Robbins (3) f.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
v FOR DEDUCTION FROM ASSESSED VALUATION F I F
"' State Porn 43709(R11/609) INi
Presrnbed by Department of Local Government Finance
J
File Mark
•NSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property J A, o: "•�'SiL
P Y tl' b h P Party is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ Co my Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months , • WIi n Recorder
before March 31 of each year the deduction is sought My
+1E1 _ _
See reverse side for additional instructions a qualifications. GIBSON
Ap• . (o -rorcontract buyer-see ' • on reverse side)
I, 1/1// Key number/legal description Record number Page umber
/ "�t(�7Y/_/ d64-is -)-o - aoo -000, 5y6 - 0 A 7 IA � 73
Assessed value of real proprty a4of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness Lm paid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
157 5o0 El Yes El No
If no,what is his/her exact share of interest? If owned with someone other tilt/(spouse,Skate with whom
If name on record Is different than that of applicant Indicate below Ls the property in question:Annually Assessed
79
• rteaI Property ❑Annually Assessed
Mobile Home(lc 6-1.1-7)
Name of mortgagee or contract seller - i `
Address of mortgagee or contract seller(number and steel,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
PT C PE AD - a - /0 q , -7056 4C_,
Does applicant own property in any other If yes,what county? What Taxing District? Has current year?
been requested on property
county in Indiana? ❑ Yes ❑ No
❑ Yes ❑ No
® __ -
goo
—
Deducton approved In the amount at
LC y L
•
20 20 20 20 / 2_SV 73/43
Signature AUdrton Cou
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and met._ - .1a and
I owner I contract buyer of the aforementioned property on date application is filed.
Signet, ure vme/s fur name) Date(month,day,year)
. �fl
„yam resident address4f applicant(number and street,r3Y,state,and ZIP code)
//257 , )5c1 S �&4ty • IA-76 20
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 /
Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •
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