HomeMy WebLinkAboutMortgage_Baehl,.�°�•�E � STATEMENT OF MORTGAGE OR CONTRACT �`�1����N Falin -fee $1.00
e = INDEBTEDNESS FOR DEDUCTION FROM ASSESSED �ounfy` `=To ��;'tiipo, Year
�� � VALUATION State Form 43709 (1-90) Prescribed by the �
�'"""`' State Board of Tax Commissioners OOOZ g '-�
� _ � �p-�-� ile Mark
Instructions for filing: � ��
To be filed in person or by mail with the County Auditor of ihe county where the � �
property is located during the 12 months before May 11 of the year the deduction \
is to be effective. See reverse tor additional instructions and qualifications.
Applicant (�wner or contract bu er - e restrictions reve s
��
Tax"ing District Key Nu r/Legal Des Record No. _�/ ��
/�
-Ga 70 �- o�' Page No. lp
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
00 C�
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:
Name of mortgagee or contract seller
� �
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? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 19'b �a' �b � ri ��D,� k9' �U 19 19� Q�%
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Signature _ Secretary of Board of Review Date Q 8 p y
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
��nts wasfwere a resident of Indiana and owner of the aforementioned property on March 1, 19
atu e(owners full name) „ Person authorized by duly executed Power of Attorney or
�� by IC 6-1.1-12-.07).
ull Resideni Ad ress of Aplicant Address of Authorized Person
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