Mortgage_Price (2)i�.�"+, STATEMENT OF MORTGAGE OR CONTRA� E S
! FOR DEDUCTION FROM ASSESSED VAL ��
' Sta;eFwma3709(R701i1-08)
� PrescnCetl Cy Depanment o! Loral Govemmem Finance
wsravcnoNS: DEC � � 2012
Gibson � Montgomery
File Mark
To be �led in person o� by mail with fhe Counry Audifor of fhe counry where fhe p�operty i I r�. �,(t�
Filing Dates: 7) Real Pmperty: Must file dunng the year7or whiGt fhe deduction is soGbd��
2) Mobile / Manu/acmred Homes not assessed as Real Property: Musf file dunng fh e 12) rponths 6efore Marcb 37 0/ each year
See reverse sideffor add fio( al ins'ru �"ons and qualifications. G�gSON COUNTY AUD�Ta�s
Appliwnt (ownercvmntracf Cuyer- see resMCtions on reverse side)
Curtis N. Price and Tamara S. Price
Taxing Oi54iU Key numCeN legal Cescription Record number Page number
Mongomery 26-17-77-300-000.364-027/Pt of SW Qtr of Sec 17, township 3 S �
Assessetl vah�e ot real pfoperry as of Mortgage / Convact indebtedness unpaitl as of Mortgage I Con;raa intlebteCness unpaiE as uf Is Ihe applicani the sde
MarM 1, artent year March 1, cunent year date af aDP�icaUOn legal or equitade owne0
$122,637.00 x❑ Yes ❑ No
It no, whal is Ns I her ezaci share of interest? If owneE wiN someone olher than spouse, inCicata wiih whom
It name on recortl is Eiflerem Ihan Ihai oi apoticant, indiwte belov.: Is Ne pmperty in queslion: Mnuatly AsSesseC
❑X Real Property ❑ MnuallyASSessed
Mobile Home QC 67J-7)
Name of moRgagee w cronUact seller
Bank of America
AdOress oi mort9agee w mnVad se0er (number arM sheet, ury, sare. antl ZIP catle)
2018 Powers Ferry Rd. Ste 700 Atlanta, GA 30339
Nama of assynee or oNer owner or holtler o/ rtartgage
Address of assignee (number antl street. ciry, sfate, and ZlPCOtle)
Dces appfinnt own property in any oUer If yes, Mut counry? W�ai Taxing District9 Has Nis tletlucGOn been reQUesteE on pmDe
wunryinlMiana? fvcurtentYea(/ '
❑ Yes No ❑ Yes � No
COUNTY AUDITOR
Deduction approveC in Ihe amoum o@
20 20 _ 20 _ 20 _ 20 _ 20 _ 20
Sgnamre of CounryAUdtor ( Caunty Date (mmN. day, yean
I I We certify under Ne penalty of perjury lhat Ihe above and foregoing infortnation is We and wnect and that Ihe applicant is a resident of Indiana and
owner I conVact buyer of the remenfioned property on date applicaGon is filed.
Sig ' (owneYS Jull na, e) Date (mmN. tlay, yea�
12I13I2072
Full resiCent aCEress of applicant (num0er arM sLeet, city, sfare, antl ZIP code)
7381 S. 1100 W Owensville, IN 47665
Perwn authwized by dvN executetl Power olAttomey or by IC G7.1-12-0J Data (rtwnN. day, yea�
AEtlress af au•Jwr¢eA person (num0er and street. ciry, stare. aM ZIP code)