HomeMy WebLinkAboutMortgage_Smith (19) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Towns i Year
FOR DEDUCTION FROM ASSESSED VALUATION �J
--44 State Form 43709(R11/6-09)
LPrescribed by Department o Finance f Local Government Finance
File Mark
INSTRUCTIONS:
SEP c r>! ,;�r,
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 a Gou r • ditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought , di—• aunty Recorder
a -
See reverse side for additional instructions and qualifications. G I BSO N C 'u. • • .
Azcti(owner or coWyer-see • • on reverse 40
Ta>i.9; ■ Key /legal description Record er
number Page number
dal, . z ea-1q -, 9_2,03-Col .a35 - oab d,/}i 537 7
Assessed value real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
March 1,anent year March 1,arrrent year date of application legal or equitable owner?
//O OoO ❑ Yes ❑ No
If no what is his I her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is different than that of apWcant.Indicate betty: Is the property in question:Annually Assessed
?eel Property ❑Mobile Homes (IC 6-1.1-7)
Name of mortgagee or con er 1... T
Add,e_.a of mortgagee or contract seller(number and street,city staa,and ZIP code)
Name of assignee or other owner or holder of mortgage ,
Address of assignee(number and street,city,state,and ZIP code) 1 O, 9,05• (k
Does applicant own property in any other If yes,what county? • D,• ?sled on property
county in Indiana? l
❑ Yes ❑ No \O I__I Yes ❑ No
c33...6
COUNT)
Deduction approved in the amount of:
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 I contract buyer of the aforementioned property on date application is filed.
re full name) n r Date(month,day,Year)
Full (number'a'nddsheeet,aIg state,and ZIP aide)
/\
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sbee4 city,state,and ZIP code) .