HomeMy WebLinkAboutMortgage_Smith (14)�,.
,
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun owns ear
_ : FOR DEDUCTION FROM ASSESSED VALUATION
, State Fortn 43709 (R71 / 6-09)
�' wr � Presrnbetl by �epartmeM of Laml Governmenl Fu�ance
INSTRUCTIONS:
To 6e fiied in erson or b maii vnth Ne Co�n Auditor or Coun Recorder o/ the ooun whele the �
P Y N N ry property is locared.
F�irg Dates: i) Real Pmperty: Must file during the year tor which tha deducUon is wught �p�� a
2J Mo6de / Manufacfured Hortres rrot assessed as Real Pmperty: Must file dunng the M1veNe (12) months
R
6efora Malch 31 ofeach yearfhe deduction rs sought G�B �N�U�unty Recorder
See reverse side for additional instruclions arM qualificatbns.
I MP��t (owrre� or convart buy,er;�sea restrirZwu m reverse sitle) �. _ .
n �w�e m recard
Name ot morigagee or mntrarl se0er
Key rwmEer / legal desaipUon RecoN numhrr Page numbu�
-ia -� 5-tioo �i ��5'ooa 7 0
M«tuage / Coniraa irdeh;ed�s unpaid a d Morigage / ContraG'vdebtedness unVaid as d Is Ure aPP��+i Ne sde
M�d� 1.°� rtent year date of ePV�� legal a equitatle owneR
(p� � ❑ Yes ❑ No
OeW�r
Address ot rtwrtgagce w mntrac[ seAer (num6er aM sheet, ci(y, stete. aM ZIP tode)
iriongaga
slafe,anc
Does aDW�nt ovm pmperty in any oNer I II yes. what couny? I What Ta •.
munry in Intliana?
❑ Yes ❑ No
20
Sigtuture of Counry AuOitw
��-�-.r�
wnt oF.
20 _ 20
someona other Ihan spouse. i`dicafa wBh whom
Is Cre G�Pe+b in Cuestim: MnuaOylv4ses5eE
�8 a� Proaenv ❑ aunwalNwssessed
Dra�ver NO: a ��f .........
::. Card i1`O. ..:3��� 7 r,a
�ls � �Ga;a�o. � . .. _
20 � 20 � 20 _ � 20
I/ We certify under ihe penalry of perjury that the above and foregoing infwmallon is W e and cortec[ ard Nat Ne applipnt is a resideni oi IrWiara aral
owner I wntraa buyer of the atwementioned property on date appliration is filed.
��DUe (ownefs hAI name) Date (monfi, day, ysa�
revEeN addres W appGCant (wmbe�antl sLee( dl};
Pddress W authorrzed person (numberarM sneel, ury. state, antl ZIP cade)
Date (mmN, tlay, yee�