HomeMy WebLinkAboutMortgage_Smith (19) a. STATEMENT OF MORTGAGE OR CONTRA( jINETE County Township Year
~' , U)�A ��A/ Ty P
�: FOR DEDUCTION FROM ASSESSED VAL TI i
° iii ; State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance APR 3 0 2014 File Mark
INSTRUCTIONS:
To be filed in Form filed with:
person or by mail with the CountyAuditor or County Recorder of the co ty whe� th. •••-:- • is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction rr I.11 i11r7p�j; County Auditor
2) Mobile/Manufactured Homes not assessed as Real Prda (tjglte;,..• ake&sti2y months
before March 31 of each year the deduction is sought. - U t l vN County Recorder
See reverse side for additional i lions and qualifications.
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Appfxanl(owner amhoea OPk-sqe --,�:. rave e) yt ' ,/I -"I d - r r t- \-
Key mamba /legal d Lion /\v l page
_�O �6- la-A� �-DO/ 6�o-c�7 Rp"j� 3b
Mardi 1.anent vats of real pro as of Iona ::oonnttttaaggindebtedness unpaid as of Mortgage/Conaad indebtedness unpaid as of Is the app&a�t the sole
year Mardi t, � tad•�Fa-I ^^ O date of apfr�alion legal or aNiatle awneR
W ❑ Yes ❑ No
If no,what is his I her exact share of interest? / If owned with someone other than spouse,indicate with whom
If name on record is different than that of appgcant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street,city,slate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street cry,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taring District? Has this deduction been requested on property
county in Indana? for current yea
❑ No year?
-� ❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Drawer )NO,020/9
_ 20 20_ 20 20
4Card NO. :... 0. ...... County Date(month day year)
474 0.CC9_. .
_ _ land foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract uuyt..,._.- _. in dat application is filed.
411 -71-9
- hr9 rrarro� Date(month.day.Year)
resident ad• --of applicant(number a street oily,state,and ZIP code)
f//�� /v97 F TACTOL'.✓ ro
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) •
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