HomeMy WebLinkAboutMortgage_Robinson (10) Cam,: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County ,Township t r
FOR DEDUCTION FROM ASSESSED VALUATION
a' • f- State Form 43709(R11/609) jlit
- ' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: F .4� .1t i
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought . Coup i Au rAU r
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought er
See reverse side for additional instructions and qualifications. GI=- C - - - • - -
Applicant( er or c trap buyer-see restrictions on reverse side) �
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Ta: •District Key number)legal description Record number Page number
a 1 :.. try •fl - Ve -t'ir - et=ei. 5oS-ma- 1 .2013 a.8 0a
• - value of real••.., as of 3 Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1... -.year March 1,current year date of appacoban legal otable owner?
9J�tfl es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I��,e property in question:Annually Assessed
Real Property ❑Annually Assessed
\\ Mobile Home(IC 6-1.1-7)
Name offmm1`ortrtgagee or cony seller
Address of nangagee or contract seller(number and sheet,ray,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - - i
Address of assignee(number and street,city,state,and ZIP code) "- •
Does applicant own property in any other r(�� If yes,what county? • What Tarir \O••• e+ty
county in Indiana? ❑ Yes LX-RO Do 1\�C, i No
COUNTY AUDITOR J\�
Deduction approved in the amount of: Ca`
20 20 20_ 20 2 I 20 20
Signature of County Auditor • County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
SIg = (s bra r/�� ��/V/JrJ/��< — Date(mom,day,year)
I resident address of applicant(number and sheet,city,state,and ZIP code)
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arson authorized by duty executed Power of Altomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of auamraed person (number and street,city,state,and ZIP code) .