HomeMy WebLinkAboutMortgage_Smith (13)�,���� , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i�� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�J State Fwm 43709 (R61 S-06)
�� Presaibed by Department of Loral Gwemment Finance
INSTRUCTIONS: �--{ � ������
To be (iled in person o� by mail with the County Auditor of the county vihere the p�operty is located.g
Filing Dates: 7) Real Property: Dunng lhe 12 months before June Il of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-L 7J: Between January 15 and March 2 of the year t�d�c�r�� be e8ective.
See reverse side (or additional instnictions and quali/ications.
(owner or
Taxing Distrid
on
Key number / legal description (/ � Record number
a/'/� /p /„I�OD.'7 Raqe number
v' �� � — y� dki
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cu t year owneR ❑ Yes ❑ No
�.'�OoO
If no, what is his / her exad share of interest? If owned with someone olher lhan spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below: Is the property in question:
of mortgagee or contrad seller
Address of moRgagee or contrect seller (number and st2et, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and st�et, city, state, ZIP code)
Dces applipnt own property in any other I If yes, what county? I What Taxing Distrid?
county in Indiana?
l.t�.�QiClfr) �. i�"^+-*i�
llra�vcr NO �7— � �q�p oR
Dedudion approved in the: � � """"' •
� �:
Signature
C�1'(1 �`�
20- �� �.__�.._
zo., . .,,
. . .'Ry�iFf �� . . . . . .
County Auditor
20
❑ Real Property ❑ Mobile Hmie (IC 6�1.1-
Has this dedudion been requested on
property for current year? Q Yes ❑ No
20
Date
20
We certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that lhe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
IAddress of authorized person
ST