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HomeMy WebLinkAboutMortgage_Montgomery (3) ..Aa n. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year ry(.-, �, FOR DEDUCTION FROM ASSESSED VALUATION '•2 State ?bed 43709 Departure 10-15) o ■'-_I__ :: •3 �O�' Presrnbed by DeparbneM of Lop?Government Fnance 1 i� .'Fi - ' �ji INSTRUCTIONS:To be filed in person or by mail. Form filed vat Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sough© T 1 20 r County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope ❑ tY located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder 2) Mobile/Manufactured Homes not sessed as Real Property:Must file with the County Auud�f clout i�r�er the where the properly is located during the twelve 12 months before March 31 of each See m side for additional instructonsand quaiificauons. GIBSONCOUNTYA(JnITOR (owner or contract buyer-see on reverse side) •0 � .r a description 7s / Page nCumb(jer Pop ! 24 �6 - /eo- 00a • 7Gd - ° act Recwdn�r 1592 value of real property as of Mortgage I Contract indebtedness unpaid as or Mortgage l Contract iridetitedness unpaid as of Is the applicard the sole nt date,current year assessment date,current year date of application _ or equitable owner? a5 of 70 ❑ yes El No If no,what is his/her exact share of hterest? If owned with someone other Ian 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 ❑ AnnuallyAssessed • Mobile Hon(IC 6-1.1-7) Name of mortgag-e Address of mortgagee or contact seller(number• d street dry, 1-,and LP code) Name of assignee or otter owner or holder of Mortgage 770kL- tic c('L Address of assignee(number and street dry,state,and ZIP code) l,Q v 1\ Does applicant awn property in any If yes,what county? What Taxing District? M o l'�, `40•�2 / Q"�`�t 1� W deduction other county J In Indiana? ❑Yes ❑No V- 4, YES A person i s not e n t i t l e d to t h i s d e d u c t i o n u n l e s s t h e p e r s o n has a balance on the p \0- 1,..T_(co 1 in the county recorder's office(including any home equity line of credit that is recorded in the cc 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/contract buyer of the aforemen••ned pro•erty on date application is filed. )(Signature C. rr e) m C; beZp/�i /y�Full r_'•.a"ad•. /of app ( ,ber and city. and ZIP code) /1 1 � // '\ 13 7 7 A• 00 •1�/y�� P.-; authorized by duty executed Power 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) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.