HomeMy WebLinkAboutMortgage_Montgomery (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: ,«. ! State Fortn 4370y (R5/4-03) ._, � � �. �
� PrescdDed by Department of Local Gdvemmenl Finance
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INSTRUCTIONS: F�i��}g�l 7 20��
To be filed in person or by mail with the CountyAuditor of the county where the propeRy is located.
Filing Dates: i) Real PropeRy: During fhe 12 months be%re May 11 of fhe year the deduction is to be eflectiv � � C
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the yea� the duction`is \t ybe eJfectivev
See reverse side for additional instnictions and qualifications. � GI9SON COU TY „UDITC.',
buyer- see restnctions on
Assessed value oi real property'as of
March 1, curtent year
If no, what is his / her exad share of interest?
Ii name on record is different than
of moRgagee or contrad seller
Key number / legai description
number
� � ( _ _ � � �� _/y-� Page number ,
�7 L.IJ
MoAgage / Contrad indebtedness unpaid as of Is lhe applipnt the sole legal or
March 1, cunenl year owneR ❑ Yes ❑ No
indicate below:
If owned with someone other than spouse, indicate with whom.
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Address of mortgagee or contract selier (number an� �� pi��� d -
Name of assignee or other owner o�'" ��� � I� V� wo y
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Address of assignee (num6erand � ^ (j
Does applicant own property in any o0
county in Indiana?
Deduction approved
20
Signature
lhe amount of:
20 �
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Is the property in question:
❑ Real Property ❑ Mobile Home (IC G1.
..y. What Taxing Dislrict. Has this dedudion been requested on
� o
property for current year? � Yes ❑ No
COUNTY AUDITOR
r�T�—�i
County Auditor
20 �'1 20 _
P
Date
20
/ We certify under the penalty of perjury that the above and foregoing infarmation is true and corred and thal the applicants was / were
i yesident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed P�wer of Attomey
or by IC 6-1.1-12-.07
'1 Ad�ress of authorized pers�n
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