HomeMy WebLinkAboutMortgage_Montgomery (8) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
= `� FOR DEDUCTION FROM ASSESSED VALUATION
C
State Form 43709(R13/10-15)
,% Prescribed by Department of Local Government Finance
INSTRUCTIONS:
year. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resbictions on reverse side)
L:I fin. iQ ir\A-- Q m e.r�
Taxing District Key number/legaLdescription Record number Page number
Pr;%rc_e- a\D.-, 1 -\ -301- co i . a2o,DR • 2.01S 5\ 1.
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage i Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year _ date application^�(� (� legal or equitable owner?
10. C.G • -- ❑ Yes El No
If no,what is his/her exact shan 02,0 / g 5-/ , 7 with someone other than spouse,indicate with whom
if name on record is different that Drawer NO Is the property in question:AnnuallyAssessed
.• Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name ofmo ageeorcontracts Card NO. -, II:
Address of mortgagee or contract seller(number and street city,state,and ZIP code) r1
Name of assignee or other owner or holder of mortgage D� 41 1 7°
Address of assignee(number and street,city,state,and ZiP code) AVM\-`t%�
Does applicant own property in any If yes,what county? Nhat Taxing District? Ws)duction been requested If yes,state amount of deduction
other county ,,--,,�� property for ,,---,,�/
in Indiana ❑Yes I:B1:jo current year? IE-XS ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 • 20 ' 20• 20
Sign a of County Auditor Co my Date(month,day,year)
- b•l (te n .- k•a.- 2.rf-(•4. .
I/We certify under the penalty of perjury that the abov nd foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Ana owner's full name) Date(month,day,year)
Full rest ent address of applicant(n mber a street;city,scat,and ZIP code) �-�,,
t 1 l ae_ c ter-So(N R , -4r�'t nce_4-QrN, Z\v . �"1�'ZO
Person authorized by duly 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 year's and a fine not to exceed$10,000.