HomeMy WebLinkAboutMortgage_Deweese�,yTp44 STATEMENT OF MORTGAGE OR CONTRACT
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��_ :� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
" '' VALUATIO� State Form 43709 (t-90) Prescribed by the
'. � State Board of Tax Commissioners
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Instructions for filing:
To be fil�d in person or by mail with the County Auditor of the county where
property is located during the 12 months before May 11 of the year the deduci
is to be effective. See reverse for additional instructions and qualifications.
Applicant (Owner or co tract buyer - see restrictio� on r�evQe�fSe)
Taxing District Key Number/Legal D��rip(io� 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 rJ no
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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:
�me 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? ❑ yes J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�� 19�00 19�� 19�QQ� 1����� �j9d� 1-g-.2oo
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Signature Secretary of qo�rd of Review Date d Q
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I/We certify under penalty of perjury that the above and foregoing irtormation is true and correct and that the appli-
-�' as/were a resident of Indiana and owner of the aforementioned property on March 1, 19
i e(owners fuli name �-'tl-'`/VV Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Residen A dress of Aplicant �0� ��� Address of Authorized Person
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