HomeMy WebLinkAboutMortgage_Smith (19)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
:. - . .
State Fortn 43709 (R11/6-W)
��' ,.,. � Presaibed by Depariment of Local Govemmenl Frerxe
INSTRUCRONS: {�am
To be filed in person w 6y mail wifh the CountyAUdROr or County Recorder of the counry whefe the property is Iocated�A N 1 1��''
Filirg Dates: 1) Real Property: Must file dunng the year lor which the deductlon is soughL County Auditor
2) Mo6de /Manulactu2d Homes not assessed as Real Property: Must fiie dunng the twelve (72) monfh� .'�. �
6efore March 37 of each year the deduclion is sough[. ounry Recwder
1 �
See 2verse side for addifional instrucGons and qualifications. G IBSO r
Appfrani (owneror cwrtrdG buyer- see f�SGiraons yn reverse sitle)
Mert3i 1. anem year
If ro, what is ha / her exad share of interesl?
—oi�-.1-Oo �DO/. 3s�a-
Mortgage / Conirea'uWebtedness unpaid as of Mortgage ! C
Mamh 1, wrtent year Aate of a0pfx
!d0 �DO
If name on m.mrtl is dMerent Nan Nat o/ appGcant, i`Mitate bebw
mwigagee «
w contract seAer (numbe� arM sbeet, city, state, aM ZIP
Name of assignee or oNer ovmer or hdder ot mortgage
naaress or assgnee (n mcer ana suee4 � ra+e, ara ur coae�p
��n.. O—Q- % O
�' vi_J
Does applirant own property in oNer If yes, what c
munryinlrWiana? � .. � ..
uvauctron approvea m tr�e amount or.
20 20 20
Signature of Counry Auditor
1/ We certify urWer Ne penalty f perjury Mat e
owner / contract buyer of Ihe aforementioned pro�
�`^ Sign{�ture (owne 1�ne���)) c
' \ � IV � . ,.� Y _ 1.�. .�l�l
T VJhat Tavrg Dis
COUNTY AUDITOR
20 20
Caunry
Recortl numhr! Page number
aa ll �c��
Y� u No
Is Ihe P�PenY in Questian: Mnually Assessed
❑ Rea� arovertv ❑ nm,ua�y assessed
�
Drawer NO..�� �� .........
W�W •
Card1\O . .....................
��ap�50•°q' �
20 _ � 20
oa� (RO�m. dar, r��
i
above and (oregoing infortnation is true and cortect and Nai Ne applinnt is a resident of Indiana and
�erty on date application is filed.
tlty, sfafe, aM ZIP cotle)
`-t � ��6
Person autlmnzetl Gy Guty esewted Power o(Attor�Y w by IC G1.1-12-0.7
per.,on (number and sbeet dry. 51ate, aM LP cotle)