HomeMy WebLinkAboutMortgage_Smith (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__,. FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm d3709 (R71 / 6-09J
� � PresaibeE M DeOa��rt a1 Lod Go+emmeM Fifwce
�«.
INSTRUCTIONS: �
b be ned in person w by mail with Me CounryAuditor or Counry Recorder o� Ne county where the properry is located.
FiHrg Dafes: 1J Real Property: Must file durirg the year for which tha deduction is soughG MA
2) Mobde /ManufaUured Fbmes rat assessed as Real Property: Must file dunrrg the fweNe (72) monfhs
before March 31 ot each year the deduction is swyhG `—y�
Sea reverse side 7or addtional inshuctions arM qualificateons. p�(
I^Cd'°"t(°'w�ne'°`m"°au°uYe`� �'r1'° °"�/�}s reverseside) �/ GIBSON(
yi.e:in-.� o�% JC
ITatirg Districl KeY nanCer I legal dew�tion � Reoc
7./e���r,� ��-19-! 3-/�D-o00. `�y0-Od.S �
Atsessed vaqc d real RWMY a ot
AImU 7, avrent year
�} 110� W�18� 6�ILS ��IH Cl(2d S�ILIB
tt name cn remN
mntra�] seller
wrtem yeer
hlOicate Debr:
rtnrigagce or mntraG seDer (numher and sfreet �dY, sfele.
Name N assignee m oUler ovmer ar hold�
AdEfass ot auigneg (numDef e�; beeL
r T' ,— �
ooes apWiranl w.,� wov�r �� a^y aner
munry n Ind"ana? r-i ..
appoved In Ihe amouN ot
zo
I I We ceNfy�
ownerlcontra
�1�ture (owners
J�
udnnr „
65 7�
ler Ne penaty of p
buyer of the afo2r
1 name)
ot aod' t ( um6ei.
autM�d Gy dWy
r.�-✓— u
u y�. �c �,nm
No
aN as oi
cade)
a.99 A
W�at Ta�dtg District7
Form Aed wfth:
1 � 283(d,ry a,en�
❑ County Remrder
o�o /yY7
id as d Is Ne appfcant Ihe sde
legal «equttade ameYt
❑ Yes ❑ No
tlan spouse, indicate wRh wiwm
Is Ihe proprJty in QuesDOn: Mnualty As5es5eE
�Real RoPertY ❑ Arm�ali_I!Assessed
� e�, rea�ra�ea m pnp�ny
�� ❑ Yes ❑ No
- ��� �,� �i�k
zo zo_ Drawer NO.���••��
Counry � � i /
Card NO . ......G...............
Nat Ne above and foregoing informalion is W �( y 5�(�i � . JI3 �
�ed property on da[e apP�ication is filed.
� Date (nrnth. daY. Y��
IC
prJSm (number aM sbee; dry. sfate, eM LP code)