HomeMy WebLinkAboutMortgage_Smith (29)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ ry : FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-09)
�` PreuribeA by Deparimenl of Loml Govemrtrent Frence
�� i e ark
�STRUCTIONS: ���g
be lled in person a by mail with Ure CountyAuditor or Counry Recorder of the oounry where the propeAy is focated.
Filiny Dates: 1J Real Property: Must file dum�g the yearlor which Ne deduction is sought. un Auditw
2) Mo6ile /Manufac22d Homes rat assessed as Real Pioperty Must fiie dunng fAe hveNe (12) months C. .
6efoie March 37 0/ each year the deduction is sought C ry er
See raverse side (oradd'rtional instructions and qualifications. GIBSON COUNTY A
Appfc�t(ownerarcorwaapuyer-seere3fnrinnswrreverseside) �'f D � _
e0 rahm d 2al popertY a
1. alRnt yP2r
tt ro, what
on
�>3�a.aoo-000. �8s-oo6 ao� PYs o�
,
Aor(qage / Contraa iMe6ted�ress unpaid as W Mortgage I ConbafY fide6tedness unpaid as of Is Ne epp�nt ihe sde
�ar� t. airrent Eate of appGCation legal or epurta6k ameYt
l/ �nnJl flv� ❑r+o
app6caN, rtMirate bebw
Name oi mort8a9ee or mnttact setler 5� 3
Address d rtnrt9agce a cmVed se4er (num and street, city, sfaM. aM ZIP code)
Name of azsiyire w
naare:s
mMgage
aM sbeeC ary. slate. and ZIP cade)
Does eppli�nt ovm prapnJty In any other
counry in IMana?
❑ Yes
Oeduc�on approved'ci ihe amount oE
20_ 20_
Signanrc� Counbnuatty
_-� �,� ��
ir�,D,.
I/ We certify under Ne penatty of
ovmer I contrad buyer of the afor
�B^aP1Ce (owne/s MI name) i�
H ou�r�ed with someare aher tlan
Is tlie property in purstion: MnuallY Assessed
❑ Real Roperty ❑ NmuaOy Assessed
nwa� r� nc �
3.I9 .�} L
Whal Ta�drg DistriC? F
4
COUNTYAUDROR '�
2D _ 20 _ 20 _
Counry
that the a e and toregoing infortnatim is we and c
ned prope on date aPWiration is filed.
dty, state, and ZIP cotle)
ezewteA Power d Anm�ey or Cy
AdEress of auMarzEO person (numbera�M sLeet, cny. sfefe, end ZIP code)
fj��
: mis aee�a;o� eee� rev� «i w�r
artent yeall � .. �
�'
Dra�vcri\`p..a o / `
.. , �
Card �\'O. . , ySo � •.
— � �ra�e �mwth. wa.- •
�
Date (rnorun. day, yem)