HomeMy WebLinkAboutMortgage_Smitley"' STATEMENT OF MORTGAGE OR CONTRACT IN�BY� SS un Township Year
_ , FOR DEDUCTION FROM ASSESSED VALUATIOIf1-i N
Stafe fortn 43709 (R71 / 609) � 1�
�' „r Pre5mbe0 q' DepartrrcN of Lxal GovemmeiY Fuwnte
JUL 2 0 CUIU FileMark
wsrnucnoNS: F� � �
b be filed in person w by mad with the CounlyAuditor w Counry Rernrtier of the counry wheie the properry is bcated.
Fitirg Dates: 1) Real Property: Must file dwiny the year /or which the deductbn is wught � �,.(�� � County Auditnr
2) Mo6Ae / ManulaUUred Homes not assessed as Real Property: Must fi7e durin 9'�e 2(�2) �Dnths
be/ae Ma�ch 31 ofeach yearNe deducton is saght GIBSON COUNTY AUDITOR � �O1"n' Re�°`der
See 2verse side for adtlitional instnxlions aM qualifications.
t(cwna�ororyptrarl uy6.seerssUirDUnsmreve�ade) � �
1/ s.i-! \
OY�(71//�m .i Q )/177J oii
A�sed vahx d real p�opnty az d
�,,,��
tl no, whal tr his / hu e�t
rcey m,m�. i �eys� aes� —�
a�-/d-i -io
Afutpage / Contraa ��
Mard� 1 ��0 9 /
H name m remd's 6IIuent Man that of a00�+4 uM'vate Eelow
Name o( imtgag� ar mntrati
.//i�/YK.
Pddress of morcga9ex w mntraC seder (nem�ber ard L�Y. smm.
or ahu wmer w MolOer ot moriga9e
ooes eppfi�arrc oM,� w�cenr ��y om�
munry in IMiana?
❑ Yes
Dcfu�tian app�oved In ttre a oum af:
N1_
Sig�LUe d Camb AW itor
'- o a8' o� P�3 a
as m Mangaga � con7an maemea��sa unc� as or Is cre eaa�t mme mle
eam of eDP� � a �° °��
❑ Yes ❑ No
awned with sarrtme aaw than spouse. hdirate wi0� v�han
Is the D�D�Y m 7uestim: Mmia�y Aueaed
❑ Real�Avpero ❑ �M�
AIOd1B Fiortie QC 61.7-;
r4y.stam.andLPOOdeJ 1O..v:O•�,•••••••• —
Dra�ver �
���.���,n �,Ta 30�?-..... �
m�m
❑ No ��, .... ]
Card
COUNTYAUDROF � �
�a���� � �
20 _ � 20 _ � 20 _ ��` N_ � 20
Counry
r�
I I We certify uMer Ne penalry ot perjury that the above aM fwegoing informatlm is true and cortect arid Nat tha applinnt is a residem ot IMia� aiW
owner I contraa buyer of Me afaeme�rtoned P�PQnY on date aPW�non is fileA.
,�wre �ow,�s nm,�eme) � . _ oa�e c,�m. aer. rean
Full fa4Eent address bl appfiiant (number arW sbeet �: smfe, aA71 LP code)
�Qld f.nh'�o S-� �r:ncei-on,�n
r«sa, aw,o�.w oy amr e=ewree ao.a oraa«ner w M�c �,.,-,z�.�
Pddress of aW�oAud Oe+son (numbefeM sbeeG �: smte.
� c�. � ,�o