HomeMy WebLinkAboutMortgage_Montgomery (5) y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r.�:-._
viz;; FOR DEDUCTION FROM ASSESSED VALUATION
-V3�'J State Form 93709 Department/6-09) {�/
��m�—�A Prescnbed by Department of local Gewemrnent Finance
F IL INSTRUCTIONS: .
filed
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought pR 2 R 1503unty Auditor
2)Mobile I Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. J/L_�
ApP,//7 or con b see rej a.--r-?c slde)� GIBSONN�C�OUNTY AUDITOR
T�axir�ls•Gtr+h�r `Key/number/legal dewip�tion Record number Page number
y i�G i x..e.(�v T t i A4- 11 - / 3 - A o 4 - O 0 3 9 9 9 - aA- p d o/s /n?65
Assessed ra m of real property as of Mortgage f Contra t indebtedness unpaid as of Mortgage I Gonad indebtedness unpaid as of Is the appfrant the sole
March 1:cart year Mardi 1,arrtent yea date of ap legal ar equitable owr ?
3/ O El Yes 0 N
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:Annually Assessed
❑Real Property ❑Annually Assessed
Mobde Home(IC 6-11-7)
Name of mortgagee or contract seller 50"N
Address of mortgagee or contract seder(number and street,cily,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(numbe�u�e(city,state,and ZIP code) 5 3 I5 y .Pr
Does appl'rirannt,`arn(_property in any oter/�A•[t/Y�ylf yes.what county? • What Taxing District? I Has this dedumm been requested on property
county in Indiana? -- — Ira.current War? O_ Y
=_wn❑ Yes ❑ No
Rt{Qn g-Sugabt. 4
COUNTY AUDITOR 1 QO
Deduction approved in the amount of: tJ
Dra wer NO.Q2015
T
20 20 20 20 20_
CardNO. 1x65
Signature of County AUddtor , -----• • - County 415,30 00
ad
/We certify under the penalty pert the above and foregoing information is true and correct and that the applicant is a cement at nurse am.'
owner I contract buyer of the aforementioned pro.-rty on date application is filed.
Signatu._(. e/s ➢ - _ �� Date(month,day,year)
// 72 Zoo
Ful� ( 36 642 apprran (number a alye and ZIP rode) `17 -o
Person authorized by duty C/executted Power of Attorney or by IC 6-1 -12-0.7 Date(month,day,}ear)
Address of authorized person (number and street city,state,and ZIP code)
•