HomeMy WebLinkAboutMortgage_Robicheaux S.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU/6-09)
Prescribed by Department of Local Government finance
File Mark
INSTRUCTIONS: .
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is)ocat 1 coed
filling Dates: 1) Real Property:Must file during the year for which the deduction is sought Elf i ',
2) Mobile/Manufactured Homes not asc+ssed as Real Property Must Re during the twelve(12)non
before March 31 of each year the deduction is sought ❑- County Recorder
See reverse side for additional instructions and qualifications. } I 1 1 i
.. .Vy� or;. .I b•— yP. on reverse site) , i oh b fS .a /O p
•Taxing District Key number I legal description p ^ / Re number
at, - 18-13-403 - 600 .9D _bad GIBSON COUNT AUDITOR
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appr�nt the sole
Mann 1:oast year March t,oa fs v date of application legal or equitable owner?
11 ❑ Yes ❑ No
If no,what is his I her exact share of Interest? 1 If owned with someone other than spouse,indicate with whom
If name on record is different tan that of applicant,indicate b Is the property in question:Annually Assessed
4(10,1,%.0. ❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seder _
Address of mortgagee or contract seder(number end street,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) Q.
pia"Cl 1`
Does applicant own property in any other If yes,what county? • What Taxing I
county in Indiana? �/•' i Yes ❑ No
❑ Yes ❑ No A �Q• . L Yes LI
Car
COUNTY AUDITOR
Deduction approved in the amount of •
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I I We certi er th•• .` -Ity of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I co tray b- -! the aforementioned properly on date application is filed.
\ Wee( :fir' �r Date(month,day,year)
R den r•• of applicant(number and sbeeay,saie.and ZIP code) —
s'b7 Cc). Loc.t'CT S? FT rAPOI, ,. I�cI Y74, t-- -- -
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)