HomeMy WebLinkAboutMortgage_Carr�,.s*•�•4 STATEMENT OF MORTGAGE OR CONTRACT
a� p` INDEBTEDNESS �FOR DEDUCTION FROM ASSESSED
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:� VALUATION State Form 43709 (1-90) P�escribed by the
� State Board of Tax Commissioners
Filinq fee $1.00
FORM 5
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Instructions for filing: .
To be filed in person or by mail with the County Auditor of.the county where the _ «Y � �i Z000
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. !.� /�
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Applicant (Owner or contract buyer - see restrictions on reverse)
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Taxing District � . Key Number/Le Description - Record Na p _�� ,/
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Q� lp ' Q/y -� Page No. %p
Assessed value of real property Mortgage/Contract Indebtedness unpaid Is the appiicant the sole legal or
of March 1, current year as of �a`rch 1, current y�r. equitable owner? O yes O no
'YD �5 OG.
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 differenLthan that of applicant, indicate below: . �
�ne of mortgagee or contract seller � th � r
Address of mortgagee or contract seller - -
Name of Assignee or other owner or holder of Mortgage.
' . . . -: . ' . .
Address 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 J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of: -
Year YearP D DZ ��� Year � 3 Year .iL� Year,?�E,.r Year ��
. .b . b y �y'� � p�
Signature Secretary of Board of Review Date �% �� �
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IIWe certify under penalty of perjury that the above and foregoiny information is true and correct and that the
�licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
5i ture (o ers full name) Person authorized by duly executed Power of Attorney or
�
- by IC 6-1.1-12-.07).
ull esident Address of Applicant Address of Authorized Person