HomeMy WebLinkAboutMortgage_Beckerle� rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`�---: : FOR DEDUCTION FROM ASSESSED VALUATION
`�, �+ State Form 03709 (R / 12-99)
� �� PresaibeA by State Board of Tax Commissioners
�
InsVuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effeclive. See
reverse side for additional instrudions and qualificalions.
Applicanl
District
buyer
Assessed value of real property as of
March t, current year
If no, what is his / her exacf share of interest?
If name on record is different than that of
of mortgagee or wntrad seller
on reverse
FORM 5
APR 3 0 2001
Key number / legal description I Record number O/
�� ( 0� _� g y oa Page number ���a
MoAgage / Contract ihdebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ��s'b - owneR ❑ Yes ❑ No
� V I
I wned with someone other than spouse, indicate with whom.
indicate below:
Address of mortgagee or contract seller (number and stieef, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicant own real propeRy in any If yes, what county? What Taxing Distrid? Has this deduction been requested on
oiher county in Indiana? property for current yea(? ❑ Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction aooroved in the amount of:
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G'S r�� . 0� lO�a ' ii?i 9 6 it ` P
Signature �� Secretary of PTABOA Date
4
I/ We certi(y under the penalty of perjury lhat the above and foregoing information is true and correct and lhat the applicants was / were
'resident of Indiana and owner of lhe aforementioned property on March 1, 20
��gign ture owners (ull name) Person authorized by duly executed Power of Attomey
_ li�__�.__/�_ orbylC6-1.1-12-.07
r'ull resident adHre"ss'of applicant �. ,_. __ : 00. Address of authorized person
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