HomeMy WebLinkAboutMortgage_Smith STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS F I E
.1:'!T.' Court own Ip ear
FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(RU/6-09)
Prescribed by Department of Local Government Finance 11 A�I H�`�r19
INSTRUCTIONS: MA"I` I Lo�3
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fenn filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. (I I
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months '' P Triune Rdrtnr
before March 31 of each year the deduction is sought. GIBSO C 0*' Ur
See reverse�,,'',side for additional instructions and qualifications. led j�//} /,'/p/')}y ,� '-{/'
Appb�,_// buyer-see on rpG�rses 4 / U-✓ /L ./�` Y/^^--/
Taxing LLlhmssbbiicta Key ba/legalldl— Recomd P-. n
J.- o_ ';_ , t_�- COI t.. _ -Deal cR mid
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid
Mardi 1,current year March 1,amen year date of as of Is the or equit ble o sole
66 legal or equitade owner?
If no,what is his/her exact share of interest? tf owned with someone other than ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different than that of applicant,indicate below I Is the property in question:Annually Assessed
' J Real Property ❑Annually Assessed
Mobile Name of mortgagee a contract seller/1/ 7 / )1 e(IC fr1.1-7)
Address of mortgagee or contract seller(number(rendd 4 ray, to a ¢*jode—
Name of assigneeaother owner or Milder of mortgage n/ // � _d_ 2-73 / _ �jn�
Address of assignee(number and street,city,state,and ZIP code) `[/j/7L ``/x�_ J� �(Jr/
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for cement year?
❑ Yes ❑ No ❑ Yes ❑ No
1 COUNTY AUDITOR
Drawer NO ao ) 3 —
20 20 20 20
Card NO. 1' /0�/\1 County Date(month,day,year)
ID3, V CL(21 rte and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner r arrmdrn wee.vi lino _..y on date application is filed.
SIg (owner's hA name)
A- Date(month,day.year)
tFull resident add d applicant(number and street,city state,end ZIP code)
- e1O7.) 350c • 0rJevIs( if-Le J.v 47i ac - -
Person authorized by duly executed Power 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)