HomeMy WebLinkAboutMortgage_Schmitt (11)�., Fa STATEMENT OF MORTGAGE OR CONTRACT
at :`- INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
. �``. �
-`•���' VALUATION State Form 43709 (1-90) Prescribed by the
�� ��� State Boa r d of T ax C ommi s si on er s
Instructions 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 efiective. See reverse for additional instructions and qualifications.
or contrc"�ct buyer -
11
Key N
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No.
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/! �/
ina fee
File Mark
���A��
DEC p 3 1991
,4ssessed 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, cu nt year. equitable owner? O yes O no
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:
of mortgagee or contract seller
of mortgagee or contract seller
or other owner or holder of
Address of Assignee
Does applicant own real property I If yes, what county?
in any other county in Indiana?
e.
0
What Taxing District?
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Signature
79�o�p �1
d�
• ' - aL r .
��.s.
Secretary of Board of Review
Has this deduction been
requested on property for current
year? ❑ yes O no
� �i
• •.
�
� : �iS
Date
�.�O--J��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
a�s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
ature (owners full name) Person authorized by duly executed Power of Attorney or
, �,� _-�-,, ,�, �-/%_ �- by IC 6-1.1-12-.07).
Full Resident Address of Aplicant
0
Address of Authorized Person