HomeMy WebLinkAboutMortgage_Montgomery (4) S. STATEMENT OF MORTGAGE OR CONTRAC <Q4D�ST E 'DI County Township Year
.> --. FOR DEDUCTION FROM ASSESSED VAL °.
State Form 43709(R11/649) g
Prescnbed by Department of Local Government Finance
INSTRUCTIONS: APR 10 2p14 File Mark
To be filed in person or mail with the County Auditor or County Recorder of the county where e • Form Ned with:
Pe by ly ry ty �•.•- is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is • i ht.- 4pmm , nths County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Mus -t, t
before March 31 of each year the deduction is sought
County Recorder
See reverse side for additional instructions and qualifications. G�IBSON COU
Applicant(own?rorrantract buyer---•restrictions Wjerse sid
Tad Dist / i ' Key number/ ation Record number Page number
cm a10 `ia /desolation ao,v iv85
Assessed value of real. ... a s• of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mach 1,anent year Ma sr ,current year
y�-r date of application legal or equitable owner?
If no,what is his/her exact share of interest? ` ,,,/� If owned with someone other than spouse,indicate with whom ❑ Yes ❑ No
If name on record a different tha�}),thhat of apprrant,indicate bello/w/� ,f� Is the property in qu.:• j Annually Assessed
6 - I1�a- `W- 005. 20.3 -D0 i ❑Real Property ratA
Mobile Horne(IC nnually Assessed 1.1-7)
Name of mortgagee or contract seller
(7.401? /_
� e)
Address of mortgagee or contract seller(number and sheet Daly,srara,and 21 e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,my state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? fur anent year?
ID yes No Yes ❑ Yes ❑ 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 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 I contract buyer of the aforementioned property on date application is filed.
tug name) Date(month,day,year)
��,tn �et
FA resident address of applicant numbe sheet rsry,star ,ard ZIP mole)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-&7 I Date(month,day,year)
Address of authorized person (number and sbee4 cdy,state,and ZIP code) .