HomeMy WebLinkAboutMortgage_Lamar�,."'��a STATEMENT OF MORTGAG
a'�: . �
3, � INDEBTEDNESS FOR DEDUCTI(
� VALUATION State Form 43709 (1
'� e• '� State Board of Tax Commissioners
� .
R CONTRACT
Filin fee $1.00
r Township Year
Instructions for filing: . �
To be filed in person or by mail with the County Auditor of the county N�here the
property is located during the 12 monihs before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant (Owner or contract
Taxing District
- see restriciions on reverse)
Key
Description
�
�
F�r����
�B �� 4 1997 �
, �> \
C.!BSl!N
� p -pp(o _p Page No. �
Assessed value oi real property as Mortgage/Contraci Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
If no, what is his/her exact share or interest? I If owned with someone other than spouse,
indicate with whom.
If name on record is di(ferent than that of applicant, indicate below:
of mortgagee or
o( mortgagee or
Name of Assignee or
seller
owner or holder of Morlgage.
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any olher county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
� s��' � s i s b4�
r���- ���-�
Signature
iso3
-b1 I�-(�
Secretary of Board of Review
0 G//•�/�i'9 T nl?
9 2AOy-
P�-�oo �
Date ���G
1� ��
� 009'-
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
was/wer a resident of Indiana and owner of the atorementioned property on March 1, 19
S�� �ature ne s full n e Person authorized by duly executed Power oi Attorney or
i,� _ �� � � _ ,� � by IC 6-1.1-12-.07).
=�(( Resident �6dre��7of Aplicant Address of Authorized Person
�P //o �j _ [�, �a o.✓ S% � -