HomeMy WebLinkAboutMortgage_Merrimant�EST�rF4 STATEMENT OF MORTGAGE OR CONTRACT
i 4 INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
+ � VALUATION State Form 43709 (1-90) Prescribed by the
—�'�`' State Board of Tax Commissioners �
�
Instructions for filing:
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 dedu n
is to be effective. See reverse for additional instructions and qualification
r,ias,-.;�
Applicant (Owner or contract buyer - see r�strictions on
.�'v� . _ 1\
District
�-u� 2 � 2000 ��
. i /7
Key'N�mber/Legal Description \ � Record No.
�
^ b a� Paqe No.
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? rJ 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 contract seller
�
�s of mo gee or contract sell
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
oi- ii%
5 /— .���
o/ - �'/U%'
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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in,the amount of:
•dl I 1-a[-
Signature _
a ���-P
�-�__3 ..I ��oY'
. . . ,,._ „ Pi'"R�o �
Secretary of Board of Review
�
Date
-y2f1��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
_�gnature wner��n m� Person authorized by duly executed Power of Attorney or
�,,� �� Y" by IC 6-1.1-12-.07).
of Aplicant
6(
Address of Authorized Person