HomeMy WebLinkAboutMortgage_Montgomery (4) 0 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year
3 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RD 16-09)
Prescribed oy Department of isal Government Finance
INSTRUCnoNS: - File Mark
To be filed in person or by malt. I I al- i
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is h l
Must be filed with the County Auditor or County Recorder of the county where the property i 1 ! aunty led
on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oft(llgp A 0 ocil
county where the property is located during the twelve(12)months before March 31 of each,veto, U
deduction is sought.
See reverse side for additional instructions and qualifications.
! .i
Applicant(owner or contract Suye•-were son,�reverse^side) �i,'T.jT��)f�mifrr
/Un� / ! c P-1 o11J Ul/ 77PtL� GIBSON COUNTY AUDITOR
Taxing Dism•t Key numoer/legal oo aiotion / Record number Page number
1210-/3- 3y-300-000, 3'12-a)lp I ao13 1133L/
Assessed value of real property as of Mortgage/Contact indebte=dness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mann 1,amen year Marc i,current year date of application legal or eoufiable owner?
55, I aO 35;en rlOO cA Yes ❑ No
If no,what ahiss/her exact snare of interest? I If owned with someone other tnan spouse,indicate with whom
If name on record is different than that of apo5an:,indicate below: ��Issy the property in question.:Annually Assessed
L�1 Real Property ❑Annually Accpce-d
Mobile Home(IC S1 1-7)
Name mortgac cr G!IsaC seller
1nleill T(J{ID �rnP Horfa e
Address of•nortcagee or contar(numoer a a steer city,sac=,and Z&code
Pa bo X 1 i t o Ni await') , L o7 lo ( -4 73
Name of assignee or other owner or nobler of mortgage
Address of assignee(number and scree:pry,sate,and ZIP code)
Does applicant own property in any other If vest what runty? What Taxing District? Has this deduction been requested on ampery
county in Indiana?
❑ Yes ® No I for current year?
LYes ❑ No
I COUNTY AUDITOR
Deduction approved in the amount of
20_ 1 20 20 20 20 20 20
Signature of County Auditor I County I Date(month,day,year)
I/Wender the penalty of perjury ove and foregoing information is true and correct and that the applicant is a'resident of Indiana and
�(,, buyer Of the aforeme•tion n date application is filed.
Sic t/Wa I Date(month,day, -car)
,- - ,,.�� 3 zz zUl3
F •resin t a•-ft a a�pa nt numb- a - — ,;state,= _tP core) /
I .
Person authorized by outv executed Power of Attorney or by IC 6-■.t-12-0.7 I Date(mouth,day.Year)
I?sores of autnor¢ed person (number and soee:dlt sate,and 2/P code)
IN