HomeMy WebLinkAboutMortgage_Montgomery"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
_.• FOR DEDUCTION FROM ASSESSED VALUATION
SFata Fortn d3709 (R11 / 6-09) �
�' w. � Presaibed by Departrtierrt ol Locai GovemmeM finante
File Mark
INSTRUCTIONS: Q C T 2
orm ee with:
To be filed in person or by mail wiN Me CounryAuditor w Counry RecoNer o! the county where the property is located.
Fdirrg Dates: 1J Real Property: M�st file dunig Ne year for which fhe deduction is soughG � County AudBnr
2) Mo6ile / Manufactured Homes rat assessed as Real Property: Must file dunng tAa twelve (12) mo`r�flJSaµ ..�1 �nry Recordu
6efore March 31 of each year the deducfion is sotght. �� �� � � L�
See reverse side foradd"rtional insfructions and qualifications. GIBSON COUN
I, owreror caRrad Tbuyer- see mstrictiou m m`e�rse� si�te�).}�-
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Tarirg Distria Key rnenber I al dewiptirn Remd number Page wmCu
'►��M-��� alo -/7-�� ,300-�/ /8a - al ao�o Yv99
A1aIN 7,
tt no, what's ha / hu
If name m �ewrd is OiReren[ than that af appMani, induate 6eb�r.
Nartre of rtnrtgagea or mnirffi se9er
oaes apptimm wm
�a,u� m i�a�a
oontrap SeOef (ntmtbe/ erld sbBel, �y.
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antl
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ntl atreeC mY• 5(afe. entl LIY tqtl�
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any ofher If yns. wtat munq?
Yes ❑ No
oea�aon �a m ure �,� m
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Sgrenne d Camb nudrcor
1 / We certify um
owner I contraC
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az
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'vde6tedness unpaid as of I
Yes L1 No
tice 7�PeRY in Oue54m: MnuaOy Assessetl
}Real RopertY ❑ Mnually Assessed
75.�5.4 L.
NTat Tadrg D'atrict9 Has ths deEuctim Oem requrstad m property
ro� wrt�� yPar+ �.,_ _ n
zo i zc
the above arW foregoing intwmation is we an<
property on date applicatlon is filed.
revtlent a0d�ess of appG[ant (numGer aM stiaet, tity,
Z5 l S. S'tv� ; c 2 �(� f
Addrea of auVror¢ed De+� (number aM sfree4 u�: state. end LP code)
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Data (lrvdt dai: Yee+l
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