HomeMy WebLinkAboutMortgage_Montgomery (16)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTQBN� un Tovmship Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION SEP 20��
State Fom 93709 (R71 / 6-09)
�' ,,,, I Prewi6ed Ey Department ol Local GovemmeN Fi�nce
C� N " v File Mark
wsrRUCnoNS:
To be filed in person or by maii with the County Auditw or Counry Recorder o! the county where thep roper�.�S� ted F�"� �� ��
FtiirgDates: 1)RealProperty:MUStldedunrn�theyearlorwhichthededucGonissoughL GIBSONCOUN�AUDITO
2 Mo6Be /Manufactured Hanes not assessed as Real Pro � County Auditnr
) perty: Must fiie dunng the hveNe (72J months
before March 37 0/ eacA year the deduction is snught. ❑ Counry Recorder
See 2verse side for additional ins(rucfions and qualilcafbns.
IAppG owrrerarcontravy uyer-uere
n a..,.-. tC w- (�, ,. ,. (�-� 111,,,,T,..Y, , .. ,. .
A� v�ue of �G
�1U�M 1, tlrfcrt yrar
It m. what fs his I Irer e�d share oi interest?
artenl yeer
�s unpai az N Mongage /
Eate of app
If ovmed wi� somea
It name on 2cptl it 6ffuent ihan Ihat ai appGmnt, mtluata Eebw.
Name of rtprtgagee a mntract se9er ��^
aji
ALdress W rtnrtgagee or mntract seAer (rv•••�•_• d•n ��.mr. �.sme»..aM.LP_aodel_ -_--.
Name ol assignre or oNer owner or hdde - •"��11
Di•a�r�ci• \'0... °C............
MEress ot assigrree (numDer arM svee4 c ' 1
Does applkant ovm D�DeRY in any other C.'j ['d � O. `�� �
, _ .....................
Drdumon y
20
Si9(aMe ot
the amount of:
�
COUNTYAUDROR
20 20 20
Counry
Recortl rw i ber Page nu33
� / Y
Med�s unpeid az ot Is Ihe appfmant the sde
kgal w eQUirade ownefl
❑ Yes ❑ No
spouse. indifate wid� �vlwm
IS C�e m Ouestion: MnuBOy A55PSSeE
I Roaertv ❑ ��r�
y
: Nis detlutlion Eeen requested an property
curtent Y��' ❑ Yes
❑ No
20 20
Date (monN, daY, Yea�
I/ We certify under ihe penalry of perjury that ihe above and foregoing infortnalion is We and cortect arW that the appiinnt i5 a resident of Indiana arM
owner I wntracl buyer ot ihe aforementioned property on date applicalion is filed.
Pelson aWmr�d Ey dWy exeweed
r'`�
�f'/
person (numbe! errd street, dty. sfate, aM ZIP code)
�� v.