HomeMy WebLinkAboutMortgage_Smith (13)STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Count�
_ FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fwm G3709 (R71 / 6-09)
� PresaiGed Gy DepertmeM of IAtal Govemmenl Finence
INSTRUC710NS:
b De ned in person a by mail wifh the CountyAVdKOr w Counry Recorder o/ fhe county where the property is,�(eQ.
FiNrg Dates: 7) Real Property: Must file dunrg fhe year /or which (he deducfior, is soughc 1 8
2) Mobile / Manulectuied Homes rrot assessed as Real Property.� Must file dunrg the (weNe ��1+fonf�
before March 31 0/ each yeer the deduclion is swyht.
See reverse side (or add�rlional inshucGOns end qualificatbns. C,BS�N C
Md�4m (owner w cm)rad DuWr�e resfirboris oq re`e+m see) eb�
T wg Di 'r1 Key' Der / IEgal desviption
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Assessed rah�e d real G�G�Y as d AbMa9e / Con r1
MeN� 7. �2n1 yGV Memh 1 artent yet
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� 11 no. what's h'a! her eYatl shere W interest?
H name on �emrd is Cillerent lhan Na� of applicant indicate belmr.
Nama of rtartga9ea m m�traa seiler
ACdress W rtprtqagee a contrad s�er (number end sbee; riN. stete.
Nama W asignee or oNer owner n Imlder ol rtqrtgage
�a� �� �, �Y �,g
���� ❑ Y�
� m � a���
No
-ai /• ��/.3-O
LIYCOOBJ
rc�.����� �.
� Counry Auditor
❑ Counry Recorder
numDP1
cegai n ea�ore mmerr
❑ Yes ❑ No
sPd+�, rtdicata witl� �Niom
Is property in Questian: MnuaBy AssesseE
Real Propeity Q MnuaRyASSessed
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Card ��'
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Sipretice d CamtY Ntlttw Loumy Data (rto+vh. EaY. Y��
I I We certify untler Ne penalry of pe(jury that the above aM toregoing infortnation is We and carect arM Nat Ne applirant is a resident ot IrMiana arM
owner / contracl buyer of the aforementioned property on date aPplication is filed. �
t appl� � r a� f, , stete, entl ��
I�iy exeWteO Powg o1 AQOrriBY a �Y IC 61.1-72-0.7
person (number aM 5bee( tity. state, en0 ZIP rntle)
oa�n Imavn. aey.
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