HomeMy WebLinkAboutMortgage_Smith (7)a
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s ear
__ s FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (R71 / 609)
` ! Presbibad by DeparbrieM af IOUI Govemrtretrt Fulante {�
�w F� 7� 2
INSTRUCTIONS:
�F y
To be filed in person a by maif witlr fhe CountyAuditor or Counry Recorder o� Ne counry where [Ae pioperty is located. `y,.�.,
Filirg Dates: 1) Real Property: Must fife durirg the year for which fhe derluclion is w�gh[. �y-� ��
2) Mobr7e / Manufactured Homes not assessed as Real Prapelly Mus! fi7e dunng the rtvelve (72J rtwnths /'—'
betora Ma�ch 31 o/each year the deduction is saghG Q�BS N�UtR+drR�lf�r
See reverse siCe for addiliona! instmctbns end qualificafions.
Ao m(owner orF�bect 6�m/- see 2st+ittioru m rev9'sesife) i
�' -�'iiin.L
m 2md is ditferent tlun Ihat of appOrant, ud'xate MJaw.
Name at mwt�ja9ee or mntrsct seYer
AEaress of mwtgagee a
Name or azsi�ee or
ary, steta, and ZIP code)
timnt own yoperty in anY oNer I If yes. what munt/1
Ind�a?_ ❑ Yes
❑ No
DeOUCtion approved In the amount
Zo _
Sigrewre d CamH nudaor
20 — � 20
C:i��
:z��
/ Uc
as at Mortgage / C<
Eate of appQc
awned with mrnearre
RemN iwmCU Page num6er
i O
idebtedness �mpaitl as of Is Me appOrani Ne mk
legal a equttade wme(�
❑ Yes ❑ No
an spouse, udimte wiM whom
Is C�e popelty N Ques7ion: Arvweoy AssessN
❑ R� Aoa�v � �N �
nweoe rwrne pc ��.t-�
D�-:������-.o. a��.�.........
Card \O. �.p,. ��Loaio.........
VJhatTaz � �1 L3�— w �Y
, ..... e,..e.. ^ _ _ ri
20 � 20 � 20
I/ We certify under the penalry of perjury Ihat the above arW foregoing infortnalion is We and mrtect and that the applirant is a resident of IrMiana arxl
owner I contract buyer of Ne aforemenlioned pmperty an date appiiration is filed.
Person authoraetl
dappfcant(numLerenCSneet,�
;n, (-ti A(7� G!/e�i-
persan (numberarW sheeG uN. sta[e. arN LP code)
ll�l �/7/ J
oa� c�+. �r, r�n
n����/ ao�!
Date (monN, daY. Y'�a�