HomeMy WebLinkAboutMortgage_Caniff4�'ST�*F STATEMENT OF MORTGAGE OR CONTRACT
+► INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
�' VALUATION State Form 43709 (1-90) Prescribed by the
��' l State Board of Tax Commissioners
Instructions 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 deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant
District
or contract buy se estrictiqn
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Key Numb �
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Filin fee $1.00
County Township Year
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Description � Record No.
No.
Assessed value 6�/real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March,l, urrent ear. equitable owner? O yes � no
5 �
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
of mortgagee or contract seller
Name of Assignee or
Address of Assignee
owner or holder of Mortgage.
s:n
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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 19�Q� �p����}��
1�� �a.�o I.a9-ol i_,ai_-��-
Signature
1 g 03—
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Secretary of Board of Review
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Date o7-jD oP o9
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March t, 19
ign�tur ovyf,�rsJ.aft��ar�ii� Person authorized by duly executed Power of Attorney or
,�l �/ G ��/ by IC 6-1.1-12-.07).
Resident Addr@ssi�iplYC�ant ll _ I Address of Authorized Person