HomeMy WebLinkAboutMortgage_Smith (11)"'^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T i Year
; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R11 / 6-09)
, � Preuribed M DepartmeN of Local Gv+emment Finance
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INSTRUCTIONS: DE —
form I�ea wim:
To be filed in person w 6y mail with the CountyAWitor or Counry Rerorde� o/ the counry where the property is located.
Filirg Dates: 1) Real Property: Must file durirg the year /or which fha deduclion is soug�t �y �. County Audiwr
2) Mo6�7e /Manufactu2d Homes rqt assessed as Real Prtrperly Must file dunng tAe twelve (12) month5 Q�' /.,�a-5
6efore Maich 37 0/ each year the deduction rs sought �� VGOUnty Reco(der
GIBSO� C
Sea reverse side lar addilional inshuctbns arM qualificafions. "
(o1��acontraC6uyer-se�.stricbw�smreee�side) � ��
If name on ttmd
Name of mortgagea a mntrari se0er
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M1�r(� age / Contraa u
Marrh 1, wrtent year
kaN. rt�Cltlte below:
- �/. .599 da � � o o P�,�o °��
0
s unpaitl az of Mortgage / Cantrafl irMebtedness unpaid as d Is ihe eppl'rcant Ihe mle
date af aPP�� o��,c � kgal or eQUilaHe vanrYl
/�O ([�1[ 1 1 ❑ Yes ❑ No
Addres of rtnrtgagee ar mntred sv�er (nuMri and straef, cdy, sbta, ard ZIP oodej
Name ot asvgnee w othu owner
lif8(Il Owll PfOpCM1Y I112f1}' Ofh¢/
Ind��a?
❑ Yes
�
Is Cie PbPertY in Ouestim: MnuaOy Assessed
�Real RoPenY ❑ �!!�Y �
srate,
�G - /- // � o.� ,9 e.
U yes. what munt)/1 Whal Tadng District7 Has �his tlr�utlim Caen Rquested m piope+ty
fora�rtenlye2(.� ❑ YCS ❑
I No
Dra���er NO...G�ll.�.�.....
s C � p
- Card NO. .....`��`f ......
5 � Ia0,000.`�
F�ID revtlmt aG� of appfxant (numAerand s+ree4 sbte, a+d
X ��23�� IJ Io0 VJ �r��t�
�re�son autln�¢etl Oy AWy exeaIletl Pwmi al HttarmY a �Y IC 67.7
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foregoing intormation is We and correct arM fhat the applinnt is a resident of Indiana and
te application is filed.
person (number arM saeel, �y. state, and ZIP mtle)
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Dafe irtp/rth. daY. Yae� _