HomeMy WebLinkAboutMortgage_Smith (36)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r s p Year
._ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R70 /11-08j
� � Presvi6adbY�WrtrtrenidLOplGwernmeNF'man� .
INSTRUCTiONS: � Fle Ma
To be filed in pe�sm or 6y me3 wiNr the CountyAWitor d fhe �unty whare the property is bcafed. .— ,� ��
Fu��y oa�es: �� Ree� ProPerry: Must rea d�y u,a yes� ro, wn;d, ore ded�,cwn is sa,9nc i�r a�.,
2) Mob�7e /Manufactured Nomes nd assesse0 as Real Property: Must 61e dunrg the fweNe (12) months 6elwe A;{6rd� 31 bJ'a�n year
meesauctiarissa,ght. GIBSON COUNTY AUDITOR
See reverse sde fa addAional iiuWCfbns and qualifications
Applicam (oxnai v wNrryyf dryor- mo res6idians m68vwse sido)
i- B Oa i Key nwhber / leqal desnipGOn Remrd number Papa number
- - 8 -3�y - oo. �� -D �� ooB aSs
AssesseE value d feal property as d Mpt�ap e I Cmtract cdehtednea unpaid as M AlMpape / Contratl indebteOnass un�eid as d Is Ihe applv,aM Iha sda
Mart�h 1. ameN yoa Marr3i 1. curratl Y�+ / Cate of applimtion I or
, egal epuRableawnaR
Q 0 ✓ . ❑ Yes ❑ No
Y no, whal is ho / her exad sha(e d i�rest7 I( owned with sortreo�re other lhan spouse, iMicate wifh wlam
u narna on recard is ca(eram �lu,o u,af a aw��++t, aieKam cew.r. Is me wo7eM � auestion: AnnuaM assessed
❑ Real Pmperty ❑ Mnualy Assessed
Mohiie Harie IC G7.1-;
Name of matBa9ee a mntred se0� y
Nama d auigree w Wher rnmer v holtler d mortBaBa
Pddrass d asigrrea (numbn ane sbco� fdy, sam, ane LP wee)
Deduclion aVCroved'm tlie amouM d
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Signatura of CouMyAUdila
20_ � 20_
v� r�q o�mat
COUNTY AUDITOR
20 20
_ -s o • a,00�. .
D�a��er � ..... •
c�ra.o. .. 5 �5.� ......
� 35� 6"-� �l
� I ZO 20
I/ We certify uMer the penalty of perjury thal ihe above and foreganq tr�fwmation is We and cared and that the appficant is a resitlent of Indiana and
owner / mnhacf Wyer of the aforementioned property on date application is filed.
�nature (owner4 Rd nanx;) �% .. Date (rt�uNh. EaY. Y��7
' FuA rasidant ai
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/ sCCef. rsfy, ffifi. sid
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a
person (num0craiw s+NOG �Y sbte. ana [IY mao)
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