HomeMy WebLinkAboutMortgage_Hesse���� , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
--: i: FOR DEDUCTION FROM ASSESSED VALUATION
�, � State Form 43709 (R / 12-99)
yu
�� pmscnhed by State Boartl ol Tax Commissioners
Instructions for filing:
To be filed in person or by maii wilh the County Auditor of the counly where the property is
located during the 12 months before May 11 of the year the deduction is to be effedive. See
reverse side for additional instruclions and qualifications.
Applicant (owner
see
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of
Key number / legal
FORM 5
Filing fee 51.00
Coun Township Year
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MAY �'�e Mark
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GIB/�NTY AUDITOR
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Record number O /
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Mortgage / Contrad indebtedness unpaid as
March 1, current year �
If name on record is different than lhat of applicant, indicate below:
'ame of mortgagee or contrad seller
Address of moRgagee or contract seller (number and street, city, s
Name of assignee or other owner or holder of mortgage
of assignee (numberand street, city, state,
Page number � 3 3 �
f Is the applicanl the sole legal or equitable
. ownef? ❑ Yes ❑ No
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If owned with omeone other than spouse, indicale with whom.
Does applicant own real property in any If yes, what county? Whai Taxing Distrid? Has this deduction been requested on
other county in Indiana? property for current yea(? � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
approved in the amounl of:
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Signature � 9 Seaetary of PTABOA Date �
P
I/ We certity under the penalty of perjury thal the above and foregoing information is true and corred and that Ihe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
full
of applicant
/O
Person authorized by duly executed Power of Attomey
ar by IC 6-1.1-12-.07
of authorized person