HomeMy WebLinkAboutMortgage_Montgomery (3)'/.��' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°li� FOR DEDUCTION FROM ASSESSED VALUATION
� w� / StateFOrtn43709 (R6/5-06)
� Resaibed by Depariment ol Lotal Gwemment fina�e
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audito� of the county whe�e [he property is located. �py�/�, �
Filing Dates: iJ Real PropeRy: Dunng the 12 months before June Il of the year the deduction is to be elfecG� �
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th��M��Jjqryfjo� i�jq� eilective.
See reverse side fo� additional instructions and qualifications.
or contract
� o
�1./�G�[--�
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
01� (.(CP�C9/ ����
If name on record is different than that of appl
of moAgagee or contract seller
K number / gal descriptio Record number
,j � � 'd.o/� 00 V 7(i -0�8 �� �O
�j _ D� ��%/ _ � Page number
/ �P � ,
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year owner? ❑ Yes ❑ No
' Ud
Q
If owned with someone ather than spouse, indicate with whom.
Address of mortgagee or conVad seller (number and
assignee or other owner or holder of mortgage
below:
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved
20
Signature
What Taxing
COUNTY AUDITOR
in the amount of:
20 �� 20 O� 20 20
1 �
Counry Audilor
s the property
❑ Real PropeAy ❑ Mobile Hane (IC 61.1-�
Dra���er NoaD.D�'���`O
, on
C8C(� \'� . ..................... l No
20
20
/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and thal lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
�S�n er�ll ame) — Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fuil'reside� addre'ss of appliqnl Address of authorized person
� � �i6 s. 6,�so-cJ