HomeMy WebLinkAboutMortgage_Smith STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountF T s r
IIf - FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R11/609)
-; „ Prescribed by Department of Local Government Finance
1- Mark
INSTRUCTIONS: II ! : I
Fonn fit-
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I . . , n •-,
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months y t yrmi�' ecorder
before March 31 of each year the deduction is sought Jr
GIBSt1N I . a I a :
See reverse side for additional instructions and qualifications.
Applicant(owner or contract b see resfrictio 'pride) (/�J�`p/�;r
Ta>prg aaia 'c m' ia-oii /62 - 002. (145-0478 Record nu Paggn— 1
Assessed value of real property as of 1/O M1M1Morttgggaaage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid l/as-M`' Is the appfiran7 t Ne sole
March 1,anent year 1 rtent ODD date of aPPlitation \` legal oO fiords O
Ill l//(�/�J Yes
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant,indicate br /lJ Is the property in question:Annually Assessed
�t-- ' 1 • ❑Real Property ❑Mod�y Assessed
V Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city.state,and ZIP code)
Name of assignee or other owner or holder of mon -
Address of assignee(number and steel,nay,slab c. 0 13
Drawer NO _
Does applicant own property in any other ?i6 Q Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ N / for current year? ❑ Yes
/ ❑ No
Card NO
Deduction approved In the amount of: l ,3r ��
20 20 20 20 • 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is tree and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
• tore(1 ottditull name) Date(month,day,year)
I "dent address of applicant umber a street,city,state,end ZIP code)
(a L3 n L
Person authorized by duty exear Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) • _. . ---