HomeMy WebLinkAboutMortgage_Lee (2)��'�° � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r'- _: FOR DEDUCTION FROM ASSESSED VALUATION
•> � S�ale Form 43709 (R / 12-99)
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� PrescrioeE by State Board ot Tax Commissioners
InsVuctions for £ling:
To be filed in person or by mail with the Counry Auditor of the county where the property is
tocated during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side tor additional instructions and qualifications.
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Appticant (owner or contract buyer = see rest6ctions
Key number / legal description
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Assessed value of real property as of MoRgage / Contract ii
March 1, current year March 1, current year
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If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
moRgagee or contrad seller
of mortgagee or
FORM 5
File ar
J
MAY 0 7 2001
I Record number
0 �
Page number
. I�T `�2 C'
unpaid as of I Is the appliqnt the sole legal or
, owne(? ❑ Yes ❑ No
If owned with someone other than spouse, indicale with whom.
and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) � v�f / D/' ���
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Does applicant own real propeRy in any If yes, what county? What Taxing District? Has this dedudion been requested on
other county in Indiana? propeRy for current yeaf� ❑ Yes ❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
zo �_ zof�- 93 a 2o Q�_ 20 �� 20
S ,�I' °l �.la P77Ff3a f'1`"R'Bo1Q—
Signature �q Secretary of PTABOA
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Date
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/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
ignature owners Iull na ) Person authorized by duty executed Power of Attomey
' � �j/�y� �j ��� or by IC 6-1.1-12-.07
resident address of applicant IAddress of authorized person
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