HomeMy WebLinkAboutMortgage_Smith (19) /%
} . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS $®�Fort] E Year
aft.<0 FOR DEDUCTION FROM ASSESSED VALUATION 1�L-{ -i/
its,.,f�" State Form 43709(81116-09)
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presoibed by Department of Local Government Finance
iik
STRUCTIONS: JAN 3•1 r1I ark
be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Form mad with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought • unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)
before March 31 of each year the deduction is sought. GIBSON COU TY DCotjnty Recorder
See reverse side for additional instructions and qualifications. ATV RR
" �see{ rrcLOns a)�
ynumber/legal description . Record number Page number
I; . 01,e) --102 -ia - .360 -00a. 3) a -oaV p.oi 7- 6,3 ?-
..value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the appleant the sole
. • 1,amen year March I,current year date of applicationnn legal or equitable owner?
50.
If no,what is his/her exact share of interest? If owned with someone other ppo se Don whom ❑ Yes ❑ No
•
If name on record Is different than that of applicant litr below ,Is the perry in question:Annually Assessed
�"ea'Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller S n
Address of mortgagee or contract seller(number end street ,state,and ZIP code)//•J'1
Name of assignee or other owner or holder of mortgage - • _ /�"�j-1
Address ofass (number and steel rily, ,and ZIP code) � . Drawer No �vra,
Does applicant own property in any other If yes,what county? What Taxing District?
manly in Indiana?
El Yes ❑ No Card NO. 7 3).
COUNTY AUDITOR oft 6W GO
Deduction approved In the amount o1:
20 20_ 20 20 20_ 20_ 20
Sigre re of Co unty Aupfwr County Date(month,day,year)
I I We certify under the penally of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner)contract buyer of the aforementioned property on date application is filed.
Signature(owner's r�$�orre) Data(month,day,year)
?IC A'!�j/
resident adtlre�Ef applicant(numberaM sneer, stare,and ZIP code)
/3516 4i G//i/e-,1An42j /4‘4_,-401/ z %' 5i7eS -
Person authorized by duly executed Pow of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .