HomeMy WebLinkAboutMortgage_Smith (44) Em,*F�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°' `-'-12 FOR DEDUCTION FROM ASSESSED VALUATION
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? L State Form 43709(R14/1-20) �J1 O Z `l0
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„�® Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or Go(ntractyb�uyer-see re tricttiions on reverse side)
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Taxing District Key number/legal description Record number Page number
028 26-• 12-06- 401- 001 ,-17o -02$ ZoZo 4ry2
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpgaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of ap cation / S W legal or q 'table owner?
`Z(7,�66 ^ Yes ❑No
If no,what is his/her exact share of interest? If owned with some ne other thai1 spouse,indicate with whom
If name on record is different than that of applicant,indicate below: e property in question:Annually Assessed
1LJ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP c.•. FIL
n �L; Q>» `- L�. (1�. OCT 07 2020
, lic_c—e_P e il #11)41& Ai/
C lit Taxing District? Has this deduction b cbity dr- IMEtatEenount of deduction
c on p
ii current yeyrear. b)Yes ❑No
I
A ')alance on the person's mortgage or contract indebtedness that is recorded in the county
re U, IJ17— S corded in the county recorder's office)that is the basis for the deduction.
_ COUNTY AUDITOR
DE _ ,
20 20 20 20 20 20 20
Signature of County Auditor tikfrhilil Ce31. _____A La?)
/ County 1 Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing inform ' n is truAnd correct and that the applicant is a resident of diana and
owner/contract buy r f the aforementi d grope date a ' n is filed. 10 .-7. 1-0
XSignature(owner's full n I Date(month,day,year)
Full resident address o p lican (num ran s r t,city,state,an ZIP code)
1707 l od -3)-y/f t 0n-3n - vl -6-
Person authorized by duly executed Power of Attdrney 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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