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INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
VALUATION State Form 43709 (t-90) Prescribed by the
�' � State Board of Tax Commissioners x
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Instructions for filing:
To be filed in person'or by mail with the County Auditor of the county where the Ma}' ? Q 199�
property is located during the 12 months before May 11 oi the year the deduction /�
is to be effective. See reverse for additional instructions and qualifications. ���� c�, /I �(1
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Applicant (Owner or contract buyer - see restrictions o reverse) .
O�Q.
Taxing Dis rict Key Num /L al De ription Record No.
QQy ^ �j � -a� Page No.
As ssed 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 � no
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:
Name of,mortgagee or contract seller
Address of mortgagee or contract seller �
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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature Secretary of Board of Review Date
� �6 20 08-/° �9=� �l���t�'�i"
I/We certify under penalty of perjury thai the above and foregoing information is true and correct and that the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�gnature (owners full name Person authorized by duly executed Power of Attorney or
' ' by IC 6-1.1-12-.07).
�I� easid�t Address of licant �(p� Address of Authorized Person
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