HomeMy WebLinkAboutMortgage_Robb (2) .. „.,,,,....v.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court ownst)ip1 ear
torFOR DEDUCTION FROM ASSESSED VALUATION
State Fee,by ee Department em) JJJIIt n
Prescribed by Departhnrd d Lod Covemmem Finance 1.1 Li
INSTRUCTIONS: DE�' f X2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property rs located. Form filed With:
Filing Oates: 1) Real Property:Must file during the year for which the deduction is sought ii_! . ditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ,is --- •Im/ i �fpr
before March31 of each year the deduction is sought GIBSON CL'*N -• ' le` UR
See reverse side for additional instructions a .ualifications.
Applicant or contract buyer-see -- on rta side)
4 a
T.• ristrict. Key r 1 legal description Record number Page .-.
1 / a , - - 03 -at O0 aas - le c i.0/ ,OO
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unipN as of Is the appfi ant the sole
Mardi 1:anent year Mardi 1,anent year date of application (/] legal or equitable owner?
lv ❑ Yes 0 No
If no,what is his r 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: Is property property in question:Annually Assessed
`yQ Real Property ❑Annually Assessed •
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / /�
Address of mortgagee or contract sell number end;d=:-;city,state,and ZIP code)
Name of assignee or other owner or ha/der of mortgage
Address of assignee(number andsbeel,city state,and ZIP code)
Does app' f If ves,what aunty? What Taxing District? Has this deduction been requested on property
county in - -.____�,;_.. . -- for current year? ❑ Yes ❑ No
Drawer )NO. 2/7 RUNTY AUDITOR
Dedudic
a Card NO �"' D1 20 20 20 20
Signets County Date(month,day,year)
I/We certify under the penal of perjury tee,............._ oing information is true and correct and that the applicant is a resident of Indiana and
er I contract buyer of the a mere nii��t��F000n aaejjjddd property on date application is filed.
` ' BA name) Date(month,day,year)
Fuca ant of i(number and street sate,and ZIP code)
xtoy 1,t,,«� 1 Qymu-ItIc c! 141(O(9S
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 street,city,state,and ZIP code)