HomeMy WebLinkAboutMortgage_Wilson (3)d'�•n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r--. : FOR DEDUCTION FROM ASSESSED VALUATION
•> � State Form a3709 (R / 12-99)
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,� Presai�eE by State Board of Tax Commissioners
InsWctions 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 dedudion is to be effedive. See
reverse side for additional instructions and qualifications.
Applicanl (owneror
District
- see restrfation on 2verse sm�;
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Key number / legal description
FORM 5
Filing fee 51.00
Coun Township Year
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� .11 �e�J �
MAY 0 7 2001
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, curtent year March 1, current year � owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below:
of mortgagee or contract seller
Address of mortgagee or contract seller (number and
Name of assignee or other owner or holder of moRgage
city,
of assignee (number and st�eet, city, state, ZIP code)
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Does applicanf own real property in any If yes, what county? What Taxing District? Has lhis deduclion been requested on
oiher county in Indiana? property for current yea�? � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in lhe amount
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iig ture Seuetary of PTABOA Date
I/ We certify under the penalty of perjury thal 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
Person authorized by duly executed Power of Attomey
ar by IC 6-1.1-12-.07
lent a�ess of applicant Address of aulhorized person
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