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HomeMy WebLinkAboutMortgage_Holcomb (2) Crt ;\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION ^ �` Stale Form 43704(R1 i I.1-20) RECEIVED 5611 ©p� f LVZQ --- .Prescribed by Department of Local Government Finance cy. INSTRUCTIONS: To be filed in person or by mail. Tom.` OCT 2 2 2020 File Mark 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 contract buyer-see restdctlons on reverse side) • 6r1 oo.l_Lec of c,®aal, d- K ss► L 9 n n ----cLcocvm I0 N71,J Taxing District Key number/legal description ecord number P ge number a(o-0C-3I 0.0 - 033. E I g - Oa.7 202-0 �. Z Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applican a sole - i assessment date,current year assessment date,current year date of application legal or equitable owner? j • O 0 Eles ❑No If no,what Is his/her exact share of Interest? If owned rth someone other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: IO Is the property In question:Annually Assessed '[Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller -- f, ,i„ EUo4jJ-r T-T n r f-ems ECUlTI.,J1�Address of mortgagee or con ract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage _. woo 2-202u Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? G} dtl tomt } f yes,state amount of deduction other county ❑Yes []`o Ioopyrey or es ❑No Indiana? A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract indebtedness 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 the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: - 20 20 20 20 20 20 1 20 Signature of County Auditor. 14 _XVI) (c::. fa) County 1 Date(month,day,year) I I We certify under the penalty of perjury that the above and foregoing information is trtland correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Sig.:t • owners rut i ame) Date(month,day,year) ,address of applicant(number end street,rstate,and ZIP code) 3 e ' I I cr ep L�—P c o�, �� �f �� o Person authorized by duly execu ed 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) Tho nnnolfino fnr nnrinn,ran innlnrro imnrionnmanf,in in hurt and a half vaare anti a rind not in PvrPPrl aan inn