HomeMy WebLinkAboutMortgage_Montgomery (3)_,
�" STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-, � FOR DEDUCTION FROM ASSESSED VALUATION
�. J S�ale Fortn 43709 (R4 / 1 d01) .
u�.
� PreSCribeA by DeparUnenl 0/ Local Govemment Finance
INSTRUCTIONS:
�� • � �
F [ 1"i�:��[�1:'�
,_'
d
To be filed in person or by mail with the County Auditor of the county where the property is located. �U� 4��2
Filing Dafes: 1) Real Property: During the 12 months belore May 11 0l the year the deduction is to be effective. �
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0/ the ar the ded tiaa' is to b eK ive.
See reverse side for additional rnstructions and qualifica6ons_ �igSON COU�T ti' AUDI70R
Applicant(ownerorcontract uyer- rest ti s n v seside) �
Taxing District y um r/ legal de tion Record number
/ , � �
/% /nj {�O �j/�/, �/� � Sg �� Page number �S
/!.f/ /1� � ui i'�
Assessed value of real property as of MoAgage / ontract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March , t year owneR ❑ Yes ❑ No
O
If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
�me of mortgagee or conirad seiier
Address of mortgagee or contract seller (number and street ty, state, ZIP
�. ��
Name of assignee or other owner or holder of mortgage
— -3(��/
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid^ Has this deduction been requested on
county in Indiana? property for wrtent year? 0 Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
2� �� 2� � 2� � 2� 2� � 2� � 2� P.
Signature County Audilor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
ture (owners full name) Person authorized by duty executed Power ot Atlomey
or by IC 6-1.1-72-.07
r id � address of ap nt Address of authorized person
o / v '�
A�,.. �� -re,� r,vb •