HomeMy WebLinkAboutMortgage_Smith (21)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 6 W)
�' � Presvibed Oy Department ol Local Govemment Finance
F
INSTRUCT70NS:
To be filed in person w by maif wiN the County Auditor or Counry Recorder o! the county where the property is located. F��� �
Filing Dates: 1) Real Property: Musf file durirg the year /or which the deduction is sought � ���di�
2) Mobde /Manufactured Homes not assessed as Real PmpeRy Mus! f+le dunng tAe Iwelve (12) mon(hs
before Maah 37 0/ each year the deduclion is soughG .�❑ Counry Recorder
See reverse side for additiWnal insfrucGons a� qualifications. _ " /j " //�
T v �}strict itey number / lepal desaiption Remrt1 number Page numbel
a -�a-i�-ao3-��3 -� o
Asessa7 vahm d� qoperty as d Abrtqape / Cantraa iMrbtedness unpai0 as of Mwigaqe I ConaaG intlebteMess unpaiC a d Is Ihe appOmnt ihe sole
Ma�d� 1, qnpst ypar Mamh i, wrtent yeer dafe ot appfxation legal or epuitade wmM
—7 3 6 ❑ Y� ❑ No
If no, wtut ts his / Mr paart share ol intemst? If wmed wiM snmeone other Ihan spouse, ind'�le wltli whom
If nartre m mnftl s tli3efait ihan Nat of appOrant, MEita[e bebw. Is Ihe property in Ouestion: MrivaOy Assessed
Real ProPenY ❑ ��Y �
A1oWle Horne (IC 61.7-i
xtgagea «mnvad
rnort9agee or mntre
rvame ot assgnee w omej ovmer or ndaer rn rtprujage
ray, sbm, arrd LP code)
naaress or assgnee lnumner em smet �Y, sm�e. arra ur cooe7
OoeS eppfitanl am pmpeM1y in any other If yes, wtu
munry in InCana? r� .. r—� ..
0
the amount of.
20
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08- I i��
GOUNTY�
5�a a, �
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20 I 20 _ I 20 _ I 20 _ I 20
�rature of Coun�Y Audimr I Caunb I oate (rtprw. tlaY• Y�h
1/ We ceNfy under Ne penalry of perjury that Ne above and foregoing infortnation is We and cortea and that the applirant is a resident of Irdiana aM
owner I mntract buyer of ihe � ed property on date appliptlon is filed.
� o /s fiN iame c Date (month. daY. yaa�
II rev0 aEdmss of a t wmber arM city te, and ZIP cotle) �
_ //�J( � - i .�/.ct'4ia,tJ !/� `r�%G'TD
rson auCq�¢ed Dy OWy ezeaitetl Power otAttomeY or by IC G7.1-12-0.7 te (monN. daY. Y��
d�¢ss at auCmraed pnson (numbe� aM strea; ciry. sfate, and LP mde) .