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�1ESTC�F4 STATEMENT OF MORTGAGE OR CONTRACT
a3��:� `; INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
,� ' VALUATION State Form 43709 (1-90) Prescribed by the
•� State Board of Tax Commissioners
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nstructions for filing:
To be filed in person or by mail with the County Auditor of the county ��here the
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant Cvner or
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Taxing District
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t�er - see restrictions on reverse)
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Key Number/Legal Description Record No.
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Filina fee $1.00
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Assessed vaiue of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes ❑ no
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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 seller /�� �'
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Address c?f mortgagee or contract seller
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Name of Assignee or other owner or holder of Mortgage.
ress of Assignee
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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of: I r
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19 19�I3(� 19�i76 �
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Secretary of Board of Review Date �
%� /94 .,�„ v � ���%� �
certify under penalty of perjury that the above and foregoing iniormation is true and correct and that the appli-
, was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�ture (owners full name) Person authorized by duly executed Power of Attorney or
,Q n„ � c��.. ,�% by IC 6-1.1-12-.07).
Resident
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Address of Authorized Person _