HomeMy WebLinkAboutMortgage_Montgomery (4) a STATEMENT OF MORTGAGE OR CONTRACT I �E1IES 't my Township Year
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�„: FOR DEDUCTION FROM ASSESSED VALUATI �:1-14.9%.--• State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance SEP i 1 2014
File Mark
INSTRUCTIONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county where-me pro•- u •tact.
Form filed witc
Filing Dates: 1) Real Property.Must Me during the year for which the deduction is sought (I�,a '�/1"T nr.t�T OR County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file durin a =1h)r rltlls
before March 31 of each year the deduction is sought G)B,SON ❑ County Recorder
See reverse side for additional instructions and qualifications.
Ap I(owner contract buyer- resb1ctions on/everse side)
Ta:dng r • Key number/legal description Record number Page number
I ",r) Ialo-►a-o73 n1 'Jo- oaR• Imo[ Koo3
Assessed vdhx of real property as of hlpngage/Contract indebtedness unpaid as of Mortgage I ConyaC indebtedness unpaid as of is the appfcant the sole
March 1:current year March 1,arrant year date of aPfacatnn legal or equitable owner?
ci5000 ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indite with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
peal Property ❑Annually Assessed
T Mobile Home(IC o-l.1-7)
Name of mortgagee or eon,.1 seller w - _
• J�1 • �* _" 1 root ^ (e__ , . C
Address of mortgagee or contra.seller(number and street,ctY.state,and ZIP code) ' I 'V I`-L,<-L `.UiX`J4,
Name of assignee or other owner orhdder of mortgage (� I - goo b
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Tax •
county in Indiana?
❑ Yes ❑ No No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20_ 20 20
Signabae 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 nbad buyer of the aforementioned property on date application is filed.
Sig
Date(nrndr,day,}war)
,'7
zifip nt of t(numbe r ✓sbaet,oYy,state,and ZIP code) /ttnioed by duty execoted Power of Attorney or by IC Gl.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code) .