HomeMy WebLinkAboutMortgage_Smith (4)�.•.�2> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou vns r
4 FOR DEDUCTION FROM ASSESSED VALUATION
S• � S�ate Form s3709 (Ri 1/ 6-09)
�' � PresaiEM by Department of Local Govemmem Finance
le M
INSTRUCTIONS:
To 6e �led in person or by maiL Form rted wim:
Filing Dates: 7J Real Property: Must be complefed and dated in fhe calendar yea�lo� which the deduction is sough[. �
Must 6e filed wifh fhe CountyAudifor or County Recorder ot the county where the ploperty is located Auditor
on or be(ore January 5 of the immediafely succeeding calendar year. ❑ ecorder
2) Mobile / Manulactured Homes not assessed as Real Property Must file with the CountyAvditor oIt�BSO
county where fhe p/operty is located dunng fhe tweNe (12J montAs be/ore March 31 o7each year the
deduction is sought.
See reverse side for additional instrucUons and qua/i�wfions.
App6cant (owrrer w contrdcf Ouyer - see resLicTions an reverse
James D. Smiih and Aimee M. Smith
Johnson
2 G 1836300-002.099-024
assessea value a reai 7�veM as a
r.tarrh 1. a`'rtepnt ye�ar,f�
ITO . Vw
If no, what is hi / her ezact share ol interesR
II name m recorC is tliflerent Nan Nat ot appticant, indiwte bebw.
mongagea or u
age Masters
or other ovmer oTtwlder of rtartgage
Address of assignee (numberanC street, dty, stafe. and ZlPCOtle)
applinnt own property
r in Ind'ana7 �
as
number Page nurt:ber
-Ibl .
as of I5 the applicanl Ne sc
date ot appGCation legal w equitable ovme(1
S207,112.00 ❑O Yes ❑ No
I( wmeE with mmeone oNer ihan spouse, indicate with whom
� 6l�
Is the property in question: MnuaOy Assessed
❑� Real Property ❑ MnualyAssessed
�7��
for
D�oPertY
COUNTY AUDITOR
Oeauclion approved in Ne artaunt ot
20 20 _ 20 _ 20 20 20 20
SgnaNre of Counry AuEitor Gounry Data (monN, Cay. yea�
I/ We certify under the penalry of perjury that the above and toregoing informafion is We and cortect and that the apD����� is a resident of Indiana and
owner I conVacl buyer of the aforemen[ioned property on date application is filed.
Signatur owne/s fWl artre • Date (monN. ag yea� '
� ` �
FuA identaCAressotappliwnt�numberarMSfreeGCiry,slate.aMLPCOde
1 W. Rabbit Run Dr., Haubstadt, IN
Person auNOrized by Cuty ezecuted Power of Attomey or Dy IC 61. f-12-0] Da:e (r+wnN. day. yeaQ
Addressotauthoraedperson (numherarrd5beef.ciry.slafe,anCZlPCOde)