HomeMy WebLinkAboutMortgage_Putt,rE;=•TMa STATEMENT OF MORTGAGE OR CONTRACT Filin fee
ar �^ " INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Towr
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�� °� VALUATION State Form 43709 (1-90) Prescribed by the
. �s�e ' State Board of Tax Commissioners
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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 �he year the deduction ess� �£�
11
Year
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is to be effective. See reverse for additional instructions and quatifications.
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App i ant (Owner or contract buyer - see restrictio s on reverse)
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Taxing District Key Number/Leg Description Record No.
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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 ❑ no
If no, what is his/her exact share or interest? If owned with someone oiher than spouse,
_ ' '�j indicate with whom.
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If name on r o d is different than that of applicant, indicate below:
'-ne of mortgagee or contract seller
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A ress of mortgagee or ntract 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? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signatur� � Secretary of Boa d of Review Date / �
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I/We certify under penalty of perjury t at the above and foregoing informetion is true and correct and that the appli-
` 's was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
S �nature (owners full name) Person authorized by duly executed Power of Attorney or
�, by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person
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