HomeMy WebLinkAboutMortgage_Smith (19) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun IV!iZ'.treiljf-.
r3i FOR DEDUCTION FROM ASSESSED VALUATION - ; ;,r ST
State Form 43709(R11/6-09)
Ptesoibed by Department of Loral Government Finance
- 1 2014
INSTRUCTIONS: .
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. Forth fled With:
Fling Dates: 1) Real Property.Must file during the year for which the deduction is sought III '- ! •i ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must tile during the twelve(12)months I ��-.'J)'��'
before March 31 of each year the deduction is sought GIBSON VI "' CDR
See reverse side for additional instructions and qualifications.
Appfuard(owner or contract buyer see on reverse e)
c&X't 4 fl \t, 1
Taring 4 number/legal description Record number Page number
caso SIA cr-lo :ireeLlr,r-rasna. s (Co" - w aa �I a.��7
vahre f rear as of I M1bngag /COntrad indebtedness unpaid as of Mortgage/Contract trade es unpaid as of lo the or equIant the sole
March 1, year Mardi Trent wear r.�� date of aPPGCadon Itly a equitable owner?
•l l 3 r TO pi:Wes ❑ No
If no,what''a Its/her exact share of interest? J If owned with someone other than space,Indicate with whom
If name on record is afferent than that of applicant.Indicate below the pea+ *Assessed tssessed
r/y�rv� nth(IC 6-1.1-7)
Name of mortgagee or contrail tYl
seller - - — ��
Address of mortgagee or contact seller(number and street.city.stare,and ZIP code) `` O ••'
Name of assignee or other owner or holder of mortgage `�``,C; ` d r
Address of assignee(number and street,city,state,and ZIP code) \O .
. Ca`J
musty pplicannoy property in any other If yes,what county? - What i -u. Has deduction been requested on property
?Yes ❑ No ❑ Yes ❑ No
ii COUNTY AUDITOR
Deduction approved In the amount of: •
20 20 20 20 20 20 20
Signature of Carty Audits - 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.
Signature(oyQer3 tuff creme) I 4 Date(month,day,year)
�resident address ofof/ rpappricanl tt(numberandt X te,and ZIP code) r rill `y/ /
G 35 ( /e)r f lJ owe ,// / 76 t�
aueomed by duly executed Power of Aaome or by IC 6-1.1-12-0.7 Date(month,day,Year)
Address of authorized person (number and sheet,dry,state,and ZIP code)