HomeMy WebLinkAboutMortgage_Smith (10)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
= FOR DEDUCTION FROM ASSESSED VALUATION
'— State Fortn A3709 (R71 / 6-09)
S aiew�eee ey oeaa�m or Local coNemrtrenc Frerce
�STRUCTIONS: ged �
To be filed in person w by mail with the Counry Auditor or Counry Recorder o/ the counry where the pioperry is loca� F�! `L ��
Fi7ing Dates: 7) Real Property: Must file dufiig Ne year /or which the deduction is sought. f CB 6 Counry Auditnr
2) Mobile / Manufactu2d Homes rrot assessed as Real PmpeRy: Mus1 file dunng the (weNe (12J months
before Maich 37 0( each year fhe deduction is soughf. C_7.n L� County Recorder
\
See reverse side !o� addiLOna/ instructions arM quali�cations. �TpR
Ap�v�nt(ownerorconvacrDuyeJr �eere sonrere �/ GIBSONC
l�/"Y)J/nrn 9` !//2ri1�' ��i�n,��C./I
If name on rem�d
Name oi mortgagee « contraU
number / legal desviption
'� - -av - �/oo a� / 7/ v
Ab�ga9e � contraa "v�tlebtea�ess ��paid as ot Abrtgac
Mart� 1, drtent year . Eate of �
applicant, inEinte Eebw:
contlaU se0er (nvmbrl and sbee{ �y, state, aM ZIP code)
AGOress of asvgnee (number antl stree4 �1: slate, and Z/P code)
Oces applil2nt ovm p�operty in any oNer It yes, what munry?
munry in Intlana?
❑ Yes ❑ No
Deduc6on app�oved in the amount of:
20 _ � 20
Sigrature of Counb Autlitor
�
'uWebtedness unPaid as of Is Ne aC�� t�e sole
legal a epuimGe owneR
❑ Yes ❑ No
Is Me pmperty in 9uestion: MnuaDy Assessed
� Real ProPertY ❑ Mnually 0.ssessed
Moble Hortie (IC E7.
s n'�, gQ-y �,� r,
D. f-1m �3�TL —
� �o�-c��// ��
)UNTYAUDIIUn �
20 20 20 20
CaunN Oate (month. daY, yea�
I/ We certify under Ne penalry of perjury that Ihe above and foregoing infortnalion is true and corteU ard that Me applirant is a resident of InCiana aM
owner I mntract Duyer of Ne aforementloned propeM1y on date appiication is filed.
.,anna m�.,�ers rwnerne� _ Cl � oate (monn,, dar. rean
re4denta�
�a��
oy
tlry state.
P4d�ss of auNO''seC person (numberaM shee4 �1y. s+a(e, and DP tode)
�4
i��W �
Oate (monN, daY. Yae�