HomeMy WebLinkAboutMortgage_Smith (18)"'�a STATEMENT OF MORTGAGE OR CONTRACT I �� un Township Year
• FOR DEDUCTION FROM ASSESSED VALUATi�
. sra�a Fom, aa�os �tn i s�os�
,�+ y. s p��y¢d by Oepartrtcent ot Lad Govemment Finarcz . '
wsrRUCnoNS:
JAN 16 2013 File Mark
To 6e filed in person or by mail wiN the CourttyAuditor or Counry Recorder of the county where the pro erty � F� �� ��
Fili Dates: 7 Real Property: Must 6te durirg the year for which the deducfion is sought Coun Audi[or
� ) Mo6Be / Manufaclured Homes rrot assessed as Real Property. Must fiIe da�ll R1�y}�, ry
6efore March 31 of each year the deduction is sought. G�BSON COUN7Y A u� � uR � Counry Recorder
See reverse side for additional instrucUons and qual�rations.
T� Di Key nwnber / legal desaipfion
n,�n ��v- 9-�5� �J' �/ GY50 '
A�eO valire of real property az ot Mortqag e/ Contrarl inde6leEnrss unpaid as ot
M2� 1. ame�rt year � Mart� 1. curtent year
If ro, what is his / her ezaci sha�e of in[erest?
If name on recortl s drtferent Nan
cmtract uller (numher and stree; c%y, slate, aM ZIP code)
a«ignee w othu owner or hdder of mortgage
Add2ss of assi9rree
Does epP�innt ovm
munry in India�?
D�ucfion appfoved
20
I/We
(number arM street aN, s+ate,
uoperty in any oNer
❑ Yes ❑ No
'vi tlre amount of:
20 _
co�,ryn,wwrtw
�
Recortl numba Page num0er
i3 a�
unpaid as of 6 Ne appfirant the sale
legal w equifa6le rnmeR
❑ Yes ❑ No
ihe Property in Question: MnuaMASSessed
�'keal Property Q {vmually Asessed
�� .U�AN
i3- a�3
If yes, what muntyt I Whal Ta�dr
COIJNTY AUDROR
20 20 20
20
20 _
C]
under the penatty oi peryury that ihe above and foregning infomiation is We and mrtect arid that the applicant is a resident of Indiana and
act buyer of ihe afo�ementioned pmperly on date appiirabon is filed. �
k fi� remel/ / _ i Date (rtronth. daY, l'ea�
ootle)
person (numberand dvee4 mY, slate, aM LP oode)
Date (rtronlh. d2Y,