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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATIO� State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be fil?d 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
is to be effective. See reverse for additional instructions and qualifications.
Township I Year
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Applicant (Owner or contract buyer - see restrictians on reverse)
Taxing Uistrict Key Num Legal Description Record No. O�
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legai or
of March 1, current year as of March 1, current year. equitable owner? O yes ❑ no
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If no, what is hislher exact share or interest? -Jf owned with someone other than spouse,
indicate wiih whom.
If name on record is different than that of applicant, indicate below:
�'-rye of mortgagee or contract seller /
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Address of mo agee or contract seller
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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? rJ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature Secretary of Board of Review Date � 6of..
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INVe certify under penalty of perjury that the above and foregoing in or tion is true and correct and that the appli-
�:was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�.yr�ature (owners fuli name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident Ad ress of Aplicant Address of Authorized Person •
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