HomeMy WebLinkAboutMortgage_Baumgarte�� rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r— .
� FOR DEDUCTION FROM ASSESSED VALUATION
'y j Stale Fwm 43709 (R / 12-99)
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� Prescribed by SWte Board of Tan Commissioners
InsVuctionsforfiling:
To be filed in person or by mail with the County Auditor of the county where the property is
located during fhe 12 months before May 11 of the year lhe dedudion is to be eHedive. See
reverse side for additional instrudions and qualifications.
Applicant (owner
Taxing Districl
-see
Assessckl value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number! legal
t/ v � � �.I`�l�
Mortgage / Contract ii
March 1, current year
fee
V File Mark
�gL��
MAY 0 8 2001
`-� Record nurr�
�/1 Page numbf
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unpaid as of Is the a
owner?
t the sole legal or
❑ Yes ❑ No
FORM 5
�
If owned with someone other than spouse, indicate wiih whom.
If name on record is different than that of applicant, indicate below:
�eme of mortgagee or contrad seller
Address of moAgagee or contracl seller (number and stieet, ity, state,
of assignee or other owner or holder of mortgage
Address of assignee (number and s6eet, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? . Has this deduction been requesied on
other county in Indiana? property for current yeaR ❑ Yes � No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
20
approved in the amount of:
�'�� �I 20 ��
�5 �-Yh A_
LZTiZ���JL� ' �
Secretary of PTABOA OPS
20
Date
20
�
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ynatur (owners full nam�,) Person authorized by duly executed Power of Attomey
��/�� � ;�i��� �� or by IC 6-1.1-12-.07
. +!
�plicant ` " � Address of authorized person
�i y ���� �, ��.39