HomeMy WebLinkAboutMortgage_Smith (18)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
_. FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R11 / 6-09)
� y�. PresaiCetl M DePaN�M of Lxal GovemmeN Firence -
F a
wsrRUCnoNS:
b be filed in person w by mail with the CounryAUditor or Counry Recorder of tAe counry where the property �s ocated. �
Frling Dates: 7) Real Property Must file dunrn� the yrear for which the deducfion is sought. Rc unry Auditor
2J Mo6de / Manufaduied Homes not assessed as Real Prtiperty: Musf file during the tweNe (72J month�P R 1 0 N
befora Maich 37 0! each year Ne dedudion is sought Counry Recorder
See reverse siCe for addilional instructions and quali�cations. �-�,„ ��/
OiStriG Key ny mCer I legal tlrsaipti
� w � �
ed ralue d real poperty as d Mortyage/ Con[
�. airan r� htar� 1. a�rrem
fiat Ls his! tmi emrl shara of Intelest?
� m amtl's EiI1Mrt�t than ihat of aPP�t 6ldirate Eebw.
Name o1 rtartgagee ar mntract sWer /
C
AdAren ot rtiortgage� ar mnbad se�er (nwiber and sfreet �::
Name ot assignee w oNer awner w halder N mortgage
AOamsa af asvgnee (numbereM sbeeL dly, state, an
Ikam own praperty in any oNer
IrMiana? ❑ Yes
Deductlon apywed in tlre amount
az d Matgage / Contrxt iriEebtedneu unpaiE as d Is Ihe eppA�nt the sole
Eate of legal or equttable rnmeR
' ���D ❑ Yes ❑ No
'' owned wiih someone dher ihan spouse. indifate with whom
is me wao�+r m o�es�m: a,�m assessed
❑ Real Roaem ❑ rvmua�Nnssessed
Drawer i�'O. °��$
No . � � . _ ......
— Card nTo. 3 7 q
� ro1, q�0_��0 ...
ias Uis Eeduclim Eaen reVUVSteE m proputy
u artent yeaR �_ �.
2q 20 � n1_
Sig�aWre d Camb Aueitw Counry Date (monfh, eaY Y��
I/ We certify urder tha penalry of perjury Nat Ne above arW foregoing intormation is We and cortect arid Nat the applinnt is a resident o( IrMiana ard
owner I contract buyer of Ne atorementioned property on date application is filed.
S� _ �(a f�Nremel� �, ���r� Date(r�w�7h.0aY.Y��
W
i:!'�
oa�e �rm�,rn. a
person (numbe�and sbee4 c% sb+& and LP cade)