HomeMy WebLinkAboutMortgage_Smith"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co p Year 2
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Farm 63709 (R71 / 6-09)
�' ,w � PresaiheE Gy �eP��M af Lad GovemmeM Firerce
iNSraucnoNS: MAy 1 ��Ma�`
To 6e �led in person w by mail with the CountyAuditw or Counry Recorder o/ Ne counry where the property is located. F� �� ��
Filing Dates: 1) Real Property: Must file during the }rear for which the deduclion is sought. C��� County AuEilor
2) Mo6ile / Manufactured Homes not assesced as Real Property Must file dunng fhe hveNe (12) rtwnths
before Mamh 31 0( each year the deduction is srought. 0� Reco�der
See reverse side tor additional instructions and qualillcations. GIBS�N C� NT
MP�rtl(oyT9rawntracfbuysr-see�shirdonsopr@versesile�� "
Disbict Key rwmber / legal tlesaipcion
�(o-� -t3�o O 3 ooc� � � �✓ �G
x1 vaAie �f mat p(operty as of / Cmtrart iMebtedness unPaid as W Mortgage I Conva�Y c
I, aarart year t, wrten[ year tlate W appfxation
�
hal ¢ his I her ezaG share of intrlesl'+ H awrod with sartrea�re other Ih
tl name on �rt1 rs Eilfe2nl Uian tltai O( dpplkant, IrMifa�¢ bebrr
Nama o� ma,gagee «ca,aaa sene,
Atltlr� of rrortgagee w mntraa
w omer owner or nolaer ot mwtgage
naamss ot asvgnee �numner am sueeG my. vate, ano c�r mae)
aM
Dces applicant own properly in any oNer I If yes. what munp? I Yrtat Taring De
counry in IMena?
. � ❑ Yes . ❑ Na
EucGon approveE in tne amount ot. 0
20 20 20
�natureofCoun Auditor
I I We certify under Ihe penal� of perjury
ovmer I contrad buyer of ihe aforemention ro�
)�ature(owneYS/u0neme) . .
FWI r�ent adtlress W app�rcant (m
// �� �. C�LG
P autho�rzed Ey dWy ezecutetl
AEErgs d ainharzed person (num
20
Remfd numDer Page number
aoi� a 33
d Is Ne appli�nt the sde
legal w equitade axrnR
❑ Yes ❑ No
spouse. iMicaze v.iN wMm
Ne D�PertY in 9ue50on: Mwaq' PssesseE
�a� PropertY Q ArmuallY Assessed
e,mm r� nc ��.
V,�,ll.........
D,�a������ �o......., �
a33$.......
C�I��O �o0.J��'�
20 I 20 1 20
��
e arW foregoing inforrt�alion is We and cortect and that the applinnt is a resident of IMiana aM
on date application is filed.
D'dte (rtMC�. deY• 1'��)
�, stare. antl [IP ootle)
p � '�L,., <!76 �f
oy ic �,-,-,z-0.�
aritl street �'. ffi(e.
Date (monN. dzY Y��