HomeMy WebLinkAboutMortgage_Williams (15)rt�° , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r--. s FOR DEDUCTION FROM ASSESSED VALUATION
y � SUte Form 43709 (R / 12-99)
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� Prescribed by State Boartl o/ 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 deduction is to be eNective. See
reverse side for additional inslructions and qualifications.
Applicant (o � orcont ct buyer- see restrictions on revers side �
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Taxing District Key number / legal description
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Assessed value of re�ljroperty as of
March 1, current year
If no, what is his / her exact share of interest?
If name on record is different than that
of mortgagee or contrad seller
FORM 5
MAR 21 2001
GIB/�NTY AU�
Record number Q �
� I lo - D I I 3 D- cz� Page number � n, I�
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Mortgage ! Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, current year ' owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
indicate be�ow:
Address of mortgagee or contract seller (number and st�eef, city, state,
Name of assiqnee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does appiicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaR ❑ Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount
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iignature Secretary of PTABOA Dale
I/ We certiry under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was ! were
'resident of Indiana and owner of lhe aforementioned property on March 1, 20
iignature (owner ull n Person authorized by duly executed Power of Attomey
� ��.�. ����i.w� or by IC 6-1.1-12-.07
IAddress of authorized person
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