HomeMy WebLinkAboutMortgage_Montgomery (3) ,.`a;. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
X7,14 State Form 43709(R11 f 6-09) -
ito ' Prescribed by Department of Local Government Finance _
- INSTRUCTIONS: i; ;.`
To be filed in person or by mail . Form tiled with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought.
Must befiled With the County Auditor or County Recorder of the county where the property is located DE 3 n�}� ounty Auditor
Ur-
on or before January 5 of the immediately succeeding calendar year. El Coun -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the A
county where the property is located during the twelve(12)months before March 31 of each year the ' .r
, ye deduction is sought
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUUiTOR
Appli t(owner or contract buyer-see ctions on reverse side)
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Tamp District Kay number legal description l �� Record numb I iPage number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,asrent year March 1,current year date of application legal or equitable owner.?
/0 7 9a-f. oo C-3 des El No
If no,what is his(her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,Indicate below Is the property in question:AnnuatiyAssessed
EA-Treat Property ❑AnnuallyAssessed
N of mortgagee or contra.[seller
Mobile Home(IC 6-1.1-7)
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Address of mortgz ee or contract seller(numbe eet city,sate,and P code)
9so C kt//t2f�"7;v£<. -/9-,cc-c q , /cr7z _cry 22 ? 4/pi 4veyor1/S, _i✓- 76,2.1/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other LI1 I If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana?
❑ Yes No for current yeah
❑ Yes E}No
COUNTY AUDITOR
Deduction approved in the amount of: -
20 20 20__ 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
Signet, owners name)
Data(month,day, 4
/� G 8/9
Full reside a dress of ap (number and street,city,state,and ZIP code)
9700 Wi✓� A. (✓£n/sv/��£ 1✓ 7 Gc
Person authored by duly executed Parer of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)