HomeMy WebLinkAboutMortgage_Robinson toe_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township 1 Year
FOR DEDUCTION FROM ASSESSED VALUATION
1 State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
Mark
INSTRUCTIONS: with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the 's
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought El County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(112)moq(hg, 20 9 County Recorder
before March 31 of each year the deduction is sought APR 1
See reverse side for additional instructions and qualifications. �//�'�/1�
Applicant(owner a.• • - . _see Ins o re � //—tit /mil rt
ai GIBsot) ..Taxing Disct � ' d
F 6—aI 500 —W l• 1\\— ■ ; 'a wW
Assessed vane of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appruan' e sole
Alarrh 1,overt year March 1. date of application legal or-• a• owner!
�� ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is dttEerent than that of applicant.indicate below: Is the property in question:Annually Assessed
0 Real Property 0 Annually Assessed
Mobile I-bole(1C 6-1.1-7)
Name of mortgagee or contract surer Q/� r�`'
Address of mortgagee or contract setter(number and t,city,pate,and ZIP coder)}Address
Name of assignee r
Address of assigner
Does applicant own I , I 1 n been requested on property .
county in Indiana? V `) .• ❑ Yes ❑ No
Deduction approved
20 _ 20
Signature of County. onth,day,year)
I/We certify un is a resident of Indiana and
owner//contras
5re(��neYs jl 'nth,day,year)
ident address_.ae,...a„yang..._�..weer,cay,stare,arra cnr oboe) ... •
QI`17 Sou# -1300 8.-1- `17)640 a it dui fIci y In,
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code) .