HomeMy WebLinkAboutMortgage_Bates� , FORM 5
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Filin fee St.oO
t-' ': FOR DEDUCTION FROM ASSESSED VALUATION 9
� , State Form 43709 (R / 12-99) COUfI TOwnShlp Year
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�� Prescnbed by Slate Baard ol Tax Commissioners
� � �le Mark
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Instructions for filing: ��.�
To be filed in person or by mail with lhe County Auditor of the county where the proper(y is �
located during the 12 months before May 71 of lhe year the dedudion is to be eHedive. See ZQO.�
reverse side for additional instructions and qualifications. rl/aY �
Applicant
Taxing Distrid
buyer-see
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Assessed value of real propeRy as of
March 1, current year
If no, what is his / her exact
of interest?
name on record is different than that of
of mortgagee or wntract seller
on Severse side)
Key number / legal description
pig80N
number
O / � �0 / � � .Q� Page number �O
MoRgage ! Contract indebtedness unpaid as of Is ihe applicant the sole legal or e
March 1, current year � owne(? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
indicate below:
Address of moRgagee or wntracl seller (number and street, city, state,
Name
Address
or other owner or holder of mortgage
and street, city, state, ZIP code)
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Does applicant own real propeAy in any If yes, what county? VJhat Taxing District? Has this deduction been requested on
other county in Indiana? property for current year? ❑ Yes ❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
amount of:
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�ignature � 9 Secretary of PTABOA Date
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I/ We certify under the penalty of perjury lhat the above and foregoing information is true and wrred and that Ihe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
�i nature (owners full name) Person authorized by duly executed Power of Attomey
� � � �^�r_ � A�� � p�j.o or by IC 6-1.1-12-.07
FuII resident address of ap icant Address of authorized person
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