HomeMy WebLinkAboutMortgage_Emge�ESTP4* STATEMENT OF MORTGAGE OR CONTRACT
���°y `; INDEBTEDNESS FOR DEDUCTION FRGM ASSESSED
��' VALUATIOf� State Form 43709 (1-90) Prescribed by the
��s�• State Board of Tax Commissioners _
1
:
Instructions for filing:
To be fil-sd 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.
Applica�, wner or contra�t b�er - ee estrictions on r�erse)
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Taxin District Key Number/Legal Descr tion
/11� � Y �'� I O/3rD�C!� f�-O �
Filin f.�e $1.00
• County Township Year
No.
File Mark
�,4
`�.
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
%��, bn)
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
of Assignee
� / `�J
owner or holder of Mortgage.
Does applicant own !eal property If yes, what county. What Taxin� District. Has this deduction been
in any other county in Indiana? requested on property for current
year? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19��OD
Signature
�o°_�
�
��
�l /,� t Li1 . � �
of Board of. Review
Date
(—/0-98'
I/We certify under penalty of perjury that the above and foregoing information 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 .
5ignature (owners full nname) Person authorized by duiy executed Power of Attorney or
� �n �.o � � .. I / � ., . a _ by IC 6-1.1-12-.07).
Full Reside„�t Addres�of Aplicagt' � Address of Authorized Person