HomeMy WebLinkAboutMortgage_Smith (15)^'no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
State Fomi 43709 (R77 / 609)
�' ,,,, � Presrnbed M �ePertment m Ln�l Govemment Frexe
File Mark
INSTRUCTIONS:
To 6e filed in person or by ma�l with the CountyAuditor or Counry Recorder o/ fhe county where the property is located.
Fitirg Dates: 1) Real PropeRy: Must file dunig Ne year for which tha deduclion is soughL � Counry AWimr
2) Mo6�7e /Manulactured Homes rrot asseued es Real Properly Must file dunng the tvreNe (72) monNs
6efvre Mamh 31 o/each year the deduction is snughG � ��
See reverse side for addrtbnal inst�uctions and qualifications. G I BSO
MM�� (owrrerw contraa �- see resuiraa�s m mverse s' je�i �..
- Key rnrtn0er/kgal desaiptim Recad numDer Page numbel
- - oo - -�a
pmperty as d Mortqag Ie l Contracl Gdehtetlness unpaid as of Mortgage / IMebtetlness unpaid as d Is �he aPPGrant the sole
Ma�d� i, arten�[ j� `�f ,�y� ' date of appGtation legal or equitaNe rnmeR
I M 'S .! )/J U ❑ Yes ❑ No
If m. what Ls his / her exarl share of inte�esYt
It name on rem�d is Q�ttemnt Nan
Name of rtwrtgagee m
mortgagee or rvntraC se�er (mm6r1 ard sveat, cdy, slate, aM ZfP mde)
Name af assi9nee w oNer owner or hddu of rtiarigage
AAdm_ss of as�gnee (number �--. � - ' .
/
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om�a, Cl`�\�, .••,'� zo
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If awned with wmeone oth� Ihan spousa, Indkate witt� whom
IWhat Tavtg DistriclT
couNrrnuorroR
zo _ zo _
Caunry
Is Ihe property in questian: Mnu�
❑ Real RoPerty ❑ �
61.
Has Nia EtburAan Eeen requested m p(openy
for wrtent yea(1 I"I .,_ _ �'l
zo
Date (month,
so _
I I We certify under ihe penalty of pe�ury Nat Ihe above and foregning infortnalion is We and corzect and that fhe applicant is a resident ot Indiana am1
owner I contrac[ buyer of the aforementioned property on date appiicatlon is filed.
1 (owne /u0 remel . � Daie (montA, daY. Y��
antl sbee4 dry, state, erd LP ootle)
b/ dtdy ezewted Powet of Aitorney Or by IC 61.7-12�.7
AOtl�¢s oi authar¢eU person
_' I Date (monfi. dzY. Y��