HomeMy WebLinkAboutMortgage_Niederhaus�,.R�r� STATEMENT OF MORTGAGE OR CONTRACT
° INDEBTEDNESS FOR DEDUCTION" FROM ASSESSED
s' VALUATION State Form 43709 (1-90) Prescribed by the
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t State Board of Tax Commissioners
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Instructions for filing: _ _ � �y�,�r�
To be filed in person or by mail with the County Auditor of the county where theC�w A�p��pR
property is located during the 12 months before May' 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications. /�.-
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Applicant (Owner or contract buyer ee restrictions reverse)
Ta ' District Key NumbedLegal Description Record Na
Cr�✓v�,0.(�i/� � " Page No.
Assessed 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, current 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 ornrecord is different than that of applicant, indicate below:
� e of mortgagee o\ntract s Iler
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Address of mortgagee or contract seller • r , .
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee - • • � : ,
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION o
Deduction approved in the amount of:
19� 19��1_-O� 19 I 19�� �p�6� 1��03 19�
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Signature Secretary of Board of Review Date
�-a-�i-99�-�-�•. �oo� 02007 �.soP-P �9-p
I/We 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
ignature (o ners full name) Person authorized by duly executed Power of Attorney or
�%//' by IC 6-1.1-12-.07).
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II Resident Address of Aplicant Address of Authorized Person
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