HomeMy WebLinkAboutMortgage_Phelps`��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
rr-. ; FOR DEDUCTION FROM ASSESSED VALUATION
'� , State Form 43709 (R / 72-99)
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- PrescnbeA by State BoaM ol Tax Commissioners
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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 effedive. See
reverse side for additional inslructions and qualifications.
(owner or contract
District
Assessed value of real property as of
March 1, current year
If no, what is his / her exact
If name on
ofinterest?
on reverse side)
Key number / legal description
FORM 5
MAY 10 2001
GIB/�t�TY AU�
number D /
bb/- 0033S-D� Pagenumber /��c
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Mortgage / Contrad fndebtedness unpaid as of Is ihe applicant the sole legal or e
March�l, curreni year � owne(? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
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than thal of applicant,
of mortgagee or contrad seller
Address of moRgagee or coniract seiler (number and st2et,
Name of assignee or other owner or holder of moRgage
Address of assignee (num6erand street, city, state, ZIP code)
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state, ZIP
Does applicanl own real property in any If yes, what county? What Taxing Distrid? Has this deduction been requested on
other county in Indiana? property for current yeaf? ❑ YesO No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount
20 D i� 20�
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s. �,���" C-a�-
Signature n y
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Secretary of PTABOA
20
20 �L 20
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Date
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I/ We certify under the penalty f perjury that the above and foregoing information is true and correct and lhat the applicants was / were
�.resident of Indiana and owner of �he aforementioned property on March 1, 20
ii ture (owners /u name) Person authorized by duly executed Power of Attomey
���_�� 1%_ �,,, or by IC 6-1.1-12-.07
ider� address of�6pplicanf IAddress of authonzed person
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