HomeMy WebLinkAboutMortgage_Davis,�=••�F. STATEMENT OF MORTGAGE OR CONTRACT Filin fee
a � INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Townsh
�� VALUATION State Form 43709 (1-90) Prescribed by the
��' =" State Board of Tax Commissioners
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Instructions for filing: � `�"�
To be filed in person or by mail with the County Auditor of the county where the �a,�_ 1 � 199�
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 (Owner or contract buyer - see restrictions on reverse)
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Tax'ing District �-rKey Number/Legal Descri�
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Record No.
No. �'1.�
Year
, O�
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Assessed value of real prop�rty as MortgagelContract 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
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:
pf mortgagee or contract seller
ress of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
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:
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Signature
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Secretary of Board of Review
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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-
,�ts was/w e a resident of Indiana and owner of the aforementioned property on March 1, 19 .
oignatur ners full namel. • / Person authorized by duly executed Power of Attorney or
1� /'_ n ���� _/ by IC 6-1.1-12-.07).
Full R,�sident Addr�s of Apiicant Address ot Authorized Person
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