HomeMy WebLinkAboutMortgage_Robinson v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
. _ ,i ' FOR DEDUCTION FROM ASSESSED VALUATION
'LED
State Form 43709(R12/6-14) J �"1
• 5 Prescribed by Department of Local Government Finance �$ JJ JL
INSTRUCTIONS: Fil- Mar FEB A1
To be filed in person or by mail. -Form 1-•with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property i A A �,ti • ditor
located on or before January 5 of the immediately succeeding calendar year. I • .:11 11i0-• my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of l gig p' ttr
where the property is located during the twelve(12)months before March 31 of each year the dedu8�81ii RR*.1•rif.0 • - • a
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
George R. Robinson and Irgrid R. Robinson
Taxing District Key number/legal description Record number Page number
F+ Branch a.b-Ili- 1£ 3W-1--0oo. 1061-DZ-6 ao CTh ' j
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owneR
lsl ono. ,Yes ❑ 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: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller •
\-\ertjime FcdernA d1+ Lln,wn
Address of mortgadee or contract seller(number and street,city,state,and IP code)
3198 f)la Sin de Awl lab e Lob u.r9A- Th /7719S6
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,stale,and ZIP code)
Does applicant own property in any If yes.what county? What Taxing District? Has this deduce requested If yes,state amount of deduction
other county on property f••
in Indiana? ❑Yes Yi No current year? ''.1 - I2 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or.. •a indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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/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.
Sign (owne's7WI n ) Da: (ma!rh day,ye r)it?timittliiiit
Full silent ad mss of ap cant(number and street,city,state and P code)
acct s c\ 11nr q7 (v 8
Person authorized by duly executed Power of Attorney or by IC 1.1-12-0.7 Date(month,day,year)
•
Address of authorized person (number and street city.state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a hall years and a fine not to exceed 510,000.