HomeMy WebLinkAboutMortgage_Riley (4)rEs�°•4 STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1
a�° ` INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
� � Count Township
�e � VALUATION State Form 43709 (1-90) Prescribed by the
�' State Board of Tax Commissioners
� e �� O $ �i � Mark
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where th ` �/
property is located during the 12 months before May i 1 of the year the deductio ✓��
is to be effective. See reverse for additional instructions and qualifications. "- �'� `�"'��T� `'���iT�a .
Applicant
T
on
� � O ����'�-�C_)
Record No.
�
�1
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, curreni year as of March current year. equitable owner? O yes O no
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
Address of mortgagee or contract seller
or other owner or holder of Mortgage.
Address of Assignee
-03- �'00 -
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�� I 19�� � 0
F
❑�
1926b�-
�� 6-I`�'6�
Secretary of
�rd� 3� �' ° r
'a/- c? nJ
��Oa{d of Review I Date
a�' � � �
� i i
I/We certify under penalty of perjury that Ihe above and foregoing information is true and correct and that the appli-
�was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
atu� (owners full� ame Person authorized by duly executed Power of Attorney or
(� � ' Q by IC 6-1.1-12-.07).
ress of Aplicant,� _„ /a �, � � A¢�ress of Authorized Person