HomeMy WebLinkAboutMortgage_Smith (29)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear �/
_ . FOR DEDUCTION FROM ASSESSED VALUATION
� . • State Fwm G3709 (R71 / 6-W) \�
�' ,«. PresaiOetl Cy DePeNnent of Local Govemment Fu�ance �\ �
, File Mark
INSTRUCTIONS: �
To 6e filed in person w by mail with fhe CountyAuditor or Counry Recorder of the aounry whe�e the property is located. F� �� ��
Fiting Dates: i) Real Property: Must file dunm,7 fhe year (or which Ihe deduction is sought. - unty Auditnr
2) Mobr7e / ManufaUUred Hanes not assessed as Real Property: Must fiie dunng the M1veHe (72) months
6e(ae March 37 of each year the deduction is swyhf. Counry Remrder
See reverse side for additronal insVUdions arM qualifica(ions.
Ta�drg
1 vahie d 2a1 PopertY es
anera ym
ro, what
nairie m
. � - �,
Matgage / Contraa 4
Mert�h 1. a�rrent year
���.
rtNkate
r7ame m rtartaes� � �,ract stlw �
Address of rnort]agee w mnvacl seller (num6ar aM straet, cdy, slate,
Nama ol a.ssignee or other wmer or halder ot morigage
AAtlrnss ot astignee (n rand snceL �; s1Ne, a n,P� ca'tle), � �
�
If yes. whal county7
eppliceN a.�n property in any oNer
ryinlMar�a? ❑ Yf5
❑ No
� eaw� m uie amounc of:
20 _ 20 _
I��of Cp�nry Auditw
�
I/ We ceN(y under thi
owner I wntrad buyei
_C27 /. 7 ,
�� ���m � w
Q
COUNTY
20 20 _
Remrd number Page evmbel
—D �o
e/ Cantrart'uW etlness �mpaiE as d Is Ne app�rani Me sde
�OW�� �gal w eWttade owne!?
❑ Yes ❑ No
is Ihe property in QueSDOn: Mnue➢Y ASSessed
�e� �.o�e^y ❑ n�,^uany as�ea
What Tadng D'atrirv "—_— —_..••.•a m oroperty
Dra�ti�er i\'O.�Q.��........ . �
C:ll"(� 1�'0. ..��q _
� ����I��� .............. —
Caunry Dam prwEh, daY 3�� �
y o( rjury that N a ve aM foregoing infomialion is We and cortect arW that the applicant is a resident of Indiana arM
aforemer�tioned p o rry on deta appliration is filed.
Date (rtpNh, deY. Y��)
"WI reddepnt edOm<ss d a1ppf/aani (�nu/mber antl sbnret rn}; sfate. aM LP cotle)
lo� A �+OU L�l //%w // r�l^GN toh , r�J �7 6
Person auttomeE by tluty executed Power of AttaneY a�' IC 67.1-1 -0.�
Mdress of eWmr'vcd persm (numberaM sbeet city. sbte, eM LP cnde)
Date (monlh. EaY. Y��)