HomeMy WebLinkAboutMortgage_Smith (4) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun Pf E jfl it:r
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6O9) FF11L E '-'
Prescribed by Department of Local Government Finance J V ® 2013
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly Form filed whir
Filing Dates: 1) Real Property Must file during the ty ty P Pent Is located. " . ),,
rig Deny g year for which the deduction is sought. I�� - ^'1� ddor
2)Mobile/Manufactured Homes not acuesed as Real Property Must file during the twelve(12)month
before March 31 of each year the deduction is sought GIBSON a UNd ttlpRiOhE®R
See reverse side for additional instructions and qualifications.
a
_ _ A- i,- description- i GC �. J,r-2 5 'G 3 Po� ` J�
value of real popery as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of is the applicant the sole
Maroc,osrent veer March_Lanrent.venl date orap �r d ` legal ❑ Yes ID o Yes No
N0 , I If owned with someone other hen spouse,indicate with whom
/ n �("�-.--- Is ttryhee property in question:Annually Assessed
/Y�✓ /p / y) 1 I I l31 Real Properly ❑Moue 1.1a)
PITA �1 it‘,5 o-F-fLe v VV `
'Ord ZIP code)
2013 ' 2.6112
y� ('y) inty? - What Taxing District? Has this deduction been requested on property
��1{}`n' 1 l�l I ' ' I I for amen war? ❑ yes ❑ No
F I I COUNTY AUDITOR
20 20 20 20 20 20 20
• Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty 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.
lure( h hr0 name) Date(month, year)
re:Went aa d apLi(n /b e rr a 5 ci t y,state,and LP c o d e)(Gun,./I /I I� / 4-7 /a&/,,11nI 13
Pelson 1,510 authorized by duly F' of Attorney 6 IC 6-1.1-12-D7 0 a L ll (/f 1 (/1 /' v 1 Date( (Y tY 0 year) -
Address of authorized person (number and street,city,state,and ZIP code) _ J