HomeMy WebLinkAboutMortgage_SettleST�Tp
.� a STATEMENT OF MORTGAGE OR
� 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 deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant
District
buyer-
_ � a = a��
Number/Legal Description
.�c�
Township I Year
File Ma�rc�'"°
MAR 0 3 1999�
/�-.��/✓'
��BS�'! �`'JU�^!TY AUDlTOR
--,
Record No.
e No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid I Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? � 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:
or contract
Mddress of mortgagee o�contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own !eal 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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
• �,i , .
Signature
o � �' o
C
-03
� aoas
ry of Board of Review � Date
��Q'�.I
19_��
/
I/We certify under penaity of perjury that the above and foregoing information is true and correct and that the appli-
�ants was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
i �gnature (owners full name) Person authorized by duly executed Power of Aitorney or
.. ll �� < ! T1d�� ,, by IC 6-1.1-12-.07).
esident Address of A licant / � Address of Authorized Person
/l ,! T�o .; ?, y" �. r „ � � � „