HomeMy WebLinkAboutMortgage_Fisk,.s""'• STATEMENT OF MORTGAGE OR CONTRACT $1.00
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED r nty T n hip Year
� VALUATION State Form 43709 (1-90) Prescribed by the �-1
'�"� State Board of Tax Commissioners 1
/� ��
File a
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where t �OUNTy AUDIT�R
property is located during the 12 months before May 11 of the year the deduc GIeSON
is to be effective. See reverse for additional instructions and qualifications. �
Applicant (Owner or c tract buyer - s � Victiou o{ reverse)
Taxing District Key Number/Legal Description Record No. O
� � (p J Page No. .S�
Assessed value 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? � yes � no
If no, what is hislher 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:
�3me of mortgagee or contract seller
Address of mortgagee
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? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount oi:
i s o 1- ' -0� J�3 0 0 �.e �a a J��es � s oW � s�`L
5� 13. al �o TA-�o ��'�— ip
Signature 0� °I _ Secretary of Board of Review Date
Q
I/We certify under penaity of perjury that the above and foregoing information is true and correct and that the appli-
:ts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
ignature (owners full name) Person authorized by duly executed Power of Attorney or
ti !
�-� by IC 6 1.1-12-.07).
F II Resident A ess of A licant A dress of Authorized Person
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