HomeMy WebLinkAboutMortgage_Smith (38) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
A. FOR DEDUCTION FROM ASSESSED VALUATION
f. State Form (Rll/6-09)
St ed by Department of Local Government Finance FILE
File Mark
INSTRUCTIONS:
Form led with:
To be filed in person or by mail with the County Auditor or County Recorder of the cosuonl gr h�p is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sou�iiE V G 1 [(J I,j ns or
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
I�--� County Audit
before March 31 of each year the deduction is sought I Bo County Recorder
See reverse side fo additional instructions and qualifications.
Apparent(owner or b - ya verse side)• 1 / VISSON COUNTY AUDITOR
\
�Cber/ I tlesaiption RecoN tuber P e n her
b-I'�Ia-dot-boo- S75rodt r qa' 9
Maerh 1'Hof pmpeYy as
gel{CContrraact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appfront the sole
year r l qw c data a(apf>GCation I ❑ ❑ oN
Yes
If no,what is his/her exact share of interest? 1 If owned with someone other than spouse,indkate with whom
If name on record is different than that of applicant indicate below: Is the ro
p OenY in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r\rt /1 1 ^ _B (] c O
Address of mortgagee or contract seller(number and street city,TsIstate,land ZIP )("—,vrll(7y /I`'�I
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has thc deduction been requested on property .
county in Indiana? ❑ Yes ❑ No for currant t year? ❑ Yes
❑ No
I
I COUNTY AUDITOR
Deduction approved in the annum of:
an_ II'Vt_ -P —I—l/J 20 20 120 20
&gm v Mme' r r 'I 1 V�r"'—/ - .County 1 Data(month,day.year)
/,3- yg99
11 foregoing information is true and correct and that the applicant is a resident of Indiana and
ov e application is filed.
I Date(month,day,year)
tm m ri 'code)
Nrcin—)Ainet4 Ln ave..7sfr lie_ -.rn . 41766S
Person authorized by dory exhouted Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)