HomeMy WebLinkAboutMortgage_Stoll�s�A4x STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00 �
�a�� }° INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
���,� VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners ��/'�j'a
(�,
Instructions for filing: ����j�
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 lhe deduction JAN 1 3 1992
is to be effective. See reverse for additional i�structions and qualifications.
C� �� �-s �
Applicant (Owner or coniract buyer - see renstriction on reverse)
�. � � ".
Taxing istrict Key Number/Legal Description Record No. M �a
o�1k-u�G�CL O/3- 0 O �O / � �,/
Page No. �� % K
Assessed value oi real property as Mortgage/Contract Indebtedness unpaid Is ihe applicant the so legal or
of March 1, current year as of March t, current year. equitable owner? yes ❑ no
/i3o-i7a6o a���
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 diiferent ihan thai of applicant, indicate below:
e o( mortgag�or c�eller
Address of mortgagee or contract selier
Name of Assignee or other owner or holder oi Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has ihis deduction been
in any other county in Indiana? requested on properiy for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
1 s 1�=o 0 1 s � 1 s��' �(jQ�e 3 ��lL.� �"�e �
`a .� G-a -oz � _
Signature Secretary of Board of Review Date
0 �006 0 OS v9
l�- as-9g �3. e-�-/z. P P
I/We certiiy under penalty of perjury thal the above and toregoing information is true and correci and that the appli-
s was/were a resident of Indiana and owner o( the aforementioned property on March 1, 19
ture e na ) Person authorized by duly executed Power oi Attorney or
by IC 6-1.1-12-.07).
F esident Address o( Aplic nt Address of Authorized Person
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