HomeMy WebLinkAboutMortgage_Smith (16)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES Eou- ip Year
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; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn d3709 (R11 / 6-09) .�_
�,.,. j Presmbed by DepaNnertl ot Lacal GovemrtreM Funnce
U t � File Mark
wsrnucnoNS 1 8
To be filed in rson w b mail wiN [he Coun Auditor or Coun Recorder ot Ne coun where the ro ���'�
PQ Y �Y N b p pertyislocated.
Fitirg Da[es: 7) Real Property: M�st file dunrg the }rear for which the deduction is sought. � Counry Audimr
2) Mo6ile / Manufactured Homes iwt assessed as Real Property: Must h7e dunng the hveNe (f 2J.��i
before March 31 0! each yeer the deduction is sought. � Counry Remrder
c31BSON COUNT
See reverse side lof addifionaf instructia�s and qualifications.
MP�m(owx�maon btryer'seemstri�,0or�.sm� sife) c
��� i� i,�nn 9�-1 �/.�.n�.,., � )in�.
o�suKc
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Marfh 1, amnt year
I( ro, what Is his / her eraa sliare of inlnresC?
- 36`� - �' C,v' /Y� '7
�ge / Contract'uWehtedn¢s unpaid az
1, n�rrent year
�3��y
�,w
H name on 2md is tlifierent than Nat of applkan4 �dirate bebv.:
a
of nnrtgagee w cantrad seAer (number and sheef, cdy, state,
Name ot assignee w othrl owner or hdder ot morigage
Aild�ass ot assignce (number aiM saee4 �+Y, state, aM Z/P code)
Does epplirant am properry in any other I( yes. what
counry m Ind'ana? r-� .. r-i _.
za I 2o I zo
Record numEer Page numbu
�(� -o ac�o 9 sFs �
daM e o� eD�tan � ebteerress unDaid as ot �al � ble amM
❑ Yes ❑ No
ihe property in puestion: Mnua%PSSesud
}�eal ProPertY ❑ MnuaVY Assessed
bUbile Fiart�e (IC G7.
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Dra��'C,- NO.. � �
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I I We certfy urWer the penalry of perjury Ihal the above antl foregoing infortnation is We and cortect and that the applinnt is a resitlent of IMiana and
owner I contrad buyer of the aforemenlioned pmperty on date apP���non is filed.
�rawre (owne/s fiN name) Data (mw+fh. daY. Y��
tlent a0r�ss ot ap�nnt (numnar and stree( crry, state, ana n!' code)
78ii w �oo S D��e..�sv-���
authomed Cy dWy executed Prnwer of Atiwney or by IC Gt.t-12�.7
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Date (monN, tlay, ysa�
AEdress ot auNOmed person (numbera� sbce; rity, state, and LP mtle) . I /
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