HomeMy WebLinkAboutMortgage_Thomasn•�E STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
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°3�° ;`= INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED ty Township Year
�� � VALUATION State Form 43709 (1-90) PresGribed by the
State Board of Tax Commissioners �'�
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APR 2 0 19��1�e Mark
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where thc�,�l,y�� �. %l2�, ��
property is located during the 12 months before May 11 of the year the deduction AUDITOR �
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is [o oe erTectroe. aee reverse ror aooiiionai instructions ano quauricat�ons. ��v
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Applicant (Owner or ontract buyer - see re�ictions on reverse
Taxing District Key Number/Legal Description Record No. !��
� C� � a l� -€,osoa-oo Page No. b Y6
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? O yes O 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:
F�e of mortgagee or contract selier q
1�
Address of mortgagee or contract seller �
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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
is��-3y� is�-o� �s� � �s�pp� y�ob�_o3�B�� � oa 3 v,A6o
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Signature Secretary of Board of Review Date p�� P
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/2 � !l _ -4 �
I/We certify under penalty of pe jury that the above and foregoing information is true and correct and that the appli-
��> was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
� y�ture (owners full narr�) Person authorized by duly executed Power of Attorney or
x a n��ii by IC 6-1.1-12-.07).
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ull Resident Address of Aplicant Address of Authorized Person
/ I D cU.
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