HomeMy WebLinkAboutMortgage_Ross (2),�'T"' o STATEMENT OF MORTGAGE OR CONTRACT
Filin fee $1.00
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
VALUATION State Form 43709 (1-90) Prescribed by the
' � State Board of Tax Commissioners
�•
�Fil�� �
Instructions for filin
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 �R 2:� 2����
is to be effective. See reverse for additional instructions and qualifications. ^
Applicant (Owner or
buyer - see restrictions on reverse)
mber/Legal Description
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�^_I _ �'l�i
Record No.
No.
�,uoiTOn
Assessed value 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? � 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:
of mortgagee or�ontract seller
Address of mortgagee or contract seller
Name of Assignee or
of Assignee
owner or holder of
C
Does applicant own !eal 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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 e .v� 19 602 -a3���
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Signature
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Secretary of
1
" ��
of Review I Date �D47-P�
I/We certify under penalty of perjury thai the above and foregoing information is true and correct and ti�5t the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
Sig�ature (owners �upll name) Person authorized by duly executed Power of Attorney or
V-� r.� __ _ /'f �.. ,� _ by IC 6-1.1-12-.07). �
Resident Address of Apl4�ant � Address of Authorized Person
� L3 �B I K s f oP�'�Q4 d c� �r 60