HomeMy WebLinkAboutMortgage_Smith (3)n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi r
s� FOR DEDUCTION FROM ASSESSED VALUATION
S• � Sfate Fortn 43709 (RN / 6-09) Gibson 'b5 PelO 01
����,. r Presaihed by Departmenl o( Laral Govemment Finance
- File Mark
�STRUCTIONS:
0 6e filed in person or by mail.
Filing Dates: 7) Real Property: Must be completed and dated in the ca/entlar year for which the deduction is sought.
Must 6e filetl with the County Auditor or Counry Recorder o7the county where the propeRy is locafed
on or be%ie January 5 07 fhe immediately succeeding calendar year.
2) Mobile /Manulactured Homes nof assessed as Real Property: Must file with the CountyAuditor of the
counry wheie the property is located dun,g the 7weNe (12J months before March 37.o/each year the
deduction is sought.
F A
C Auditor
C rder
GIBSON COUN
See reverse side (o� additional insWctions and qualifications.
nppicant (owner w contract 6uyer - see resuicfions on reverse side)
Clinton J. Smith
Taxing DistriG Key number I legal desmiption R rd number Page num6er
Gibson 26-11-14300-003.185-027 p�� � �p�qY
PsseswM vak�e o( 2al pioperty as U Mortgage / Contract indebteGness unpaid as of Mortga9e / ConVaU inEebtedness unpak as of Is ihe apptipnt Ne sde
March 1, aurerrt year March 1, curtent year Eate o/ apptication legal or equitade ameR
156,800.00 0.00 54,000.00 ❑� Yes ❑ No
11 no, what is lus / her exatt share of interest? II owneE wiN someane other than spouse, indicate wi� whom
If name on recad is tli9e2nt Nan Nat ol appliwnt, intlicate bebw: Is ihe property in question: AnnuaDy Assesse0
J❑ Real Property ❑ MnuaDy Assessed
Mobi7e Home IC 61.1-7)
Name of rtart9agee or wntract uAer
First Financial Bank
Address of mortgagee w oon4acl seDer (number and streef, ciry, state, end ZIP crode)
One First Financial Plaza, Terte Haute. IN 47808
Nama of assi9nee w oNer owner w hdder of mortgage
AGdress ol assignee (numGer arM stmet, dty, state, alM ZlP code)
s applifant wm prope�y in any other It yes, what oountyt What Tapng Disinct? Has Nis EeEuction been requested on properry
unry in InEiana? tor current year?
❑ Yes ❑O No ❑ Yes ❑O No
COUNTYAUDROR
DeEUCtian appmveC in ihe amount of:
20 20 _ 20 20 20 20 20
Signature of CountyAUditw Caunry Daic (monfh, day, year)
I I We certify under the penalry of perjury that the above and foregoinq information is we and corted antl that the applicant is a resident of Indiana and
owne conV b er f the atoremenGoned property on date applica6on is filed. �
Sig r� wn s( e) Date (monlh, day, year)
11/29/2011
Fu skent address of apd��nt (number antl sfraet, crty; sfare, and ZIP cotle)
2191 W. 100 S., Princeton, IN 47670
Person authonzed �y Cuty ezecuteA Power of Attamey or by IC 67.7-12-0J Date (montli. day, year)
Addressofau'�horizedpersan (numberaMstreel,city,sfate,andZlPaode)