HomeMy WebLinkAboutMortgage_Koca (2) .M, *. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l ‘�. FOR DEDUCTION FROM ASSESSED VALUATION 1
"` 'j Z .L'%+ State Form 43709(R14/1-20) Q A C - Q ZS zo
y`��eT
'-�=•: Prescribed by Department of Local Government Finance J
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form fled 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
c�'Ckkd 2C CC Di .
Taxing District Key nu er/legal description Record number Pa a number
'S 2
Qg. -12-07 ( -000.3y8 r v� . 202 0 3 ÷ z ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ap lira t the sole
assessment date,current year assessment date,current year date of a li o 4 l o legal or q ' ble owner?
Yes ❑No
If no,what is his/her exact share of interest? If owned with som one other an spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract selle '----) .•-• I
pi.Address of mortgagee or contract seller(number and street,cit,st te,and ZIP code)
Name of assignee or other owner or holder of mortgage -461?it
Address of assignee(number and street,city,state,and ZIP code) OCT 0
6
2020
Does applicant own property in any If yes,what county? What Taxing District? Gr�& Vim ben requested If yes,state amount of deduction
other countybyty
in Indiana? [II Yes ❑No on ��/
current yea 0h-e', / a
A
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or conirac/triptebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is liitikfor the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 720 2 20 20 20 20
Signature of County -•r C) County Date MO,d y,yew ar)
W
II We certify and ale penalty of perjury tha e above and foregoing information is true and correct and that the applicant is a r ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
)(
Signature o er's full na e) Date(mon h,da year)
�~ — ' l�� �— k0 6 do
In
Fu sidgnt;dress licant u an stree city,state, cpde�
•
Person authorized by duly exe u ed Power of Attorney or by IC 6-1.1-1?0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) '