HomeMy WebLinkAboutMortgage_Lloyd (6)� rt�' . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-- i= FOR DEDUCTION FROM ASSESSED VALUATION
�, � Sfate Form 43709 (R I 12-99)
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� PresuiEetl by Slate Board ol Tax Commissioners
InsVuctions for filing:
To be filed in person or by mail wilh lhe County Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduction is to be effective. See
reverse side for additional instructions and qualifications.
fee 51.00
��� File Mark
/ �MAY 0 4 �
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FORM 5
Year
Applicant (owner or contract buye� - see rest�ctions on reverse side) v""� CO(iplT y A���r�R
`� C��
Taxing Distrid Key number / legal description Record number Q
. Page number
o�a-oo�� �oa c�
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year c��' � ay I owner? ❑ Yes ❑ No
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no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or�;ontracl seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
—I% 1
Does applicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yea(� ❑ Yes � No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
approved in the amounl of:
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,� �, �-cl �,. y�� G�ao�f
Signature
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Secretary of PTABOA
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/ We certi(y under the penalty o� perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
Address ofaulhorized person