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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing: A �
To be filed in person or by mail with the County Auditor of the county where th�B
property is located during the 12 months before May 11 of the year the deductio
is to be effective. See reverse for additional instructions and qualification�..
(Owner or
District
see restrictions on reverse)
Key Number/Legal Description
O�� -� ��- 0C�
Filin fee $1.00
Countv Township Year
.� �.'.A
2 4 20��
Mar�
�
�5 /O
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is �i�pplicant the sole I al or
of March 1, current year as of Mar h 1, current�ar. eqw�a e owner� s� no
� � (o OoO.
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
Name ot Assignee or other owner or hol
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�r of Mo_ rt�
a
Address ot =
Does applic. Dra�ver NO.. � �n/hat Taxing District? Has this deduction been
in any other i � Z^ 1 p�� requested on property for current
Card \i0 . ..................... year? ❑ yes O no
_ ___._.._ .,: REVIEW ACTION
Deduction approved in the amount of:
19_ 2d1� } I 19�b 6�
�lim ., .n/ ,e
Signature�
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� Ii6E 19�� OJ
v�' P P
Secretary of Board of Review i Date
certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
; was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
� re (owners full name) Person authorized by duly executed Power of Attorney or
�._ � __ � by IC 6-1.1-12-.07).
Address of Apiicant
Address of Authorized Person