HomeMy WebLinkAboutMortgage_Robertson (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coen =y ;' _it
bi` FOR DEDUCTION FROM ASSESSED VALUATION
��''' di State Farm 43709(Ru/6-09) '- � '
4��'^—."' Prescribed by Department of toml Government Finance
File Mark 2 0 2014
INSTRUCTIONS: .
7o be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form roa/d�vritk
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought lull tCA .n. ..jlgt------
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months G BS )t CCDul}(y afec
before March 31 of each year the deduction is sought Bc 3ITO R
See reverse side for additional instructions and qualifications.
Applicant where ,onirart buyer-see restrictions on reverse side) (.�
ktng District /legal descip' Record number Page number
t_tt_rate, ) 3-(1, - is -D-1 - ( oa - co A- „Lt.c? - na t -I t4 q34
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,crate year March 1,current year date of application legal or equitable owner?
/
lD 1 ) bIDO - '`'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 read is different than that of applicant,hdimte below: the property in question:Annually Assessed
I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of ee or contract seller —n
mo
Address of rtgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage BE 2 < (`(/ {/��
Address of assignee(number and street,city,state,and ZIP code) ��w l `rV O�i / '�” �y E/ —
Does applicant own property in any other If yes,what county? • What Ta
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county in Indiana? rrt{--��
❑ Yes kao Vo
l` COUNTY AUDITC
•
Deduction approved to the amount of:
20 20 20 20 20 20 20
Signature of County Audi= County Date(month,day,year)
-
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
‘riatinVolleds tug name) Date(month,day,,year)
f�y.�,k dart o(1 a�p�pliren/t(4lumberr and��a1qJ.ely,slate,and ZIP cod_e),, J '-7/�
‘ /3 VW r CYArI sI . F^'t rlLClcy'1) - L/76 f v •
Person 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 sheet,city,sae,and ZIP code)