HomeMy WebLinkAboutMortgage_Smith (11)°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
S1ale Form d3709 (R70 /11-08)
` I Prescribed by Departrrient af Loc� GovemmeM Firerca
wsraucnoNS: Fie Man�
ro ea �rea �� �,so„ o. ey �a �;m nre co�„uy a�e;ra. d u,a �,�� wna� a,a woaenr r5 io�cea. ,1 U N 3 0 2009
F7irg Dates: iJ Real Properfy: Must Ide Cunng fhe yeer for which the deduUion is sought.
2) Mobde / Manu/acture0 Homes not assessed as Real Property: Must fife tlum�g tl�e lweNe (72) mmths 6efae Ma'ch 310l each year
fhe de0udion is saight. �6� ��
See reverse siCe (or additional instrucGons and qualificetions
IAOP (wF�eiaimNrdcfWp�or-seeresbrlms revarsesde� �S` Cn11NTY AIIflI7nR
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" o7C0 - %�/v -
BdQB / COf1IPdG Y1E8W0EM
3� 7. curtenl year
Y ro. whaf is ha l �er eretl share d iMe�e5Y7
C name m reratl is d�erent ihan �hat of aPVFcan, iMirate beb�r.
Narne d mortpagw ar caniraci seUer� I'-
N` �
Add�ess d mo�igapee u mntrscl so0er (mmbeia C�'. s�
Name d assigree or aiher owner a Idder d mwlgape
Addfass of assipnee (rwrtAVi and sbeef. riN• ffile. and LP oo0e)
Daes a�nt wm {xaqerty in arry Gher tl yas. wha
mmty N IndareZ
❑ Yes ❑ No
Dedudion a7Gmved'm tlie artrount ot.
20 � 2� � Z(1
U �/4l
asd MoM1ga
H o+med
[a.: . �-rI`-iZRI?Y [.r
20
UII�dIdSSOF �51�18'dpQ�C211iU1850�8
legal ar ep� onrreR
❑ Yes ❑ No
sGU�se.
b me v�weM � auestian: amualty nssessed
]RealPropaAr QAnnuairyns�essea
D��a„ ��- �,�o...aoo�
;a C:11'(1 l�i�. ---c�1�1� =
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- S +�.u�-�'S�
p � S�t"'�" '
�KP��'.
I/ We certiy under tha penaity af perjury that the abwe arW (oregoing mformation is W e antl owred and that thE
owna! mnVad buyer of the a(orementbned propeM on Eate ao����n is filed.
iuo ras'afen� aearass d aaV��� (nimLame sbeef, cif�: sram, ard z�v mde)
`�-ll�l� S 7001,(� �uxv�so��llc �
Parsm au@ia¢ed by dWy emwbd Pa+rer d Atlomey w by IC 6-7.7-72-0.7
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