HomeMy WebLinkAboutMortgage_Smith (4).r "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n Year
r°�i�FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fwm 43709 (R8l 2-07)
�0�;- � Presaibed by Department of Local Govemment Finance
ark
INSTRUCTIONS:
To 6e filed in person or by mai/ with the CountyAuditor o/ the county where the propeRy is locafed. `-y„ ��
Fding Dates: 7) Real Property: Dunng the 72 monfhs belore June 77 0/ the year the deduc8on is to be eRec6ve. 0���
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 75 and March 2 0/ fhe year th��uCtiorl iStb be e ve.
See reverse side !a addi6onal instiuctions arM qualifications. ��ry COUNTY qUD170R
Appicant
anrg Disind ' Ke n r/ legal description
' .��� a:�-1�- 0-400-�t
Assessizl ralue of real popaty as af March 1, a+rent year Mw�gage /(
a�rtentyear
If rame
Name of mortgagee or conllacl seller
Address of moM1gagce a mnUaC seller (number aiM 4ieet. dty. state, and
Dces applicant own propeM in any dher
counry in Ind'ana?
❑Yes � No
amount
20 0 l I 20
M v
unpaid as of March 1, Is ihe appGpnt Ihe
someona Wier lhan spouse,
Dra�vc►• NOo.�!.�:.�G�o
C�C N . ........ ..........
. . ,d,� d��l4S CY,�.
20 _ � 20 � 20
Counry
a ��taaa o«�n
❑Yes ❑No
whom.
Is ihe property in quaslion:
❑ Real Properly ❑ Mobile Home (IC 61.
Has Uds dedudion been repuested on property
r« G,R�,i y�n
❑Yes ❑ No
20 _
Oate (monN, dey, yeen
20
I I We certify under the penalry of perjury that �e above and foregoing informatlon is true and cortect and that the appli�anis was I were a resident af
Indiana and owner of Ne atorementirn2d property on Jdarch 1, 20 . .
Person authorized
MY.
Power of Alinmey a by
person (numberandsLeeLcAy.sfate.aMZlPmtle)
Date (mon(h. tlaY.Y��
(mmth. daY. Y�A