HomeMy WebLinkAboutMortgage_Reinbrecht (3)��'�� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
--.' i� FOR DEDUCTION FROM ASSESSED VALUATION
'> > State Form 43709 (R / 72-99)
�� Presttibed by State Board of Ta:c Commissioners
InsVuctions for filing:
To be filed 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 side for addilional instructions and qualifications.
Applicant
Taxing District
buyer-see
��
Assessed value of real property as of
March 1, current year
If no. what is his / her exact share of interest?
name on record is different than that of
of mortgagee or contrad seller
on
Key number / legal
FORM 5
APR U � 2001
GIB/�NTY AU�
� � � ����" �� Page
number Q A
�
�mber Qr � �
MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legai or e
March 1, current year //� p� �� ownef? ❑ Yes ❑ No
( �O�i�� / !/
If owned with someone other lhan spouse, indicate with whom.
Address of mortgagee or contract seller (number
Name
Address of
indicate below:
or other owner or holder of moRgage
and stieet, city, state, ZIP code)
Does applicant own real property in any If yes, what county?
other counly in Indiana?
ZIP
What Taxing District?
Has lhis deduclion been requested on
property for current yeaR ❑ Yes � No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
20�� 2V4i- a? �./� 20 f) � 20 0� 20 � 20 �
'I � �
, �,��.dl b,�s.oz o �
Signature 0 9 Seuetary of PTABOA Date
P
ri �/ .
,
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�'resident of Indiana and owner of the aforementioned property on March 1, 20
Pzrson authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person