HomeMy WebLinkAboutMortgage_Sollman (6)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
` , Sfate Fortn 43709 (R3 / 1690) .
.� PteSUibeE M State Boartl of Taz Commissioners
Instructionsforfiling:
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 17 of the year the dedudion is to be effective. See
reverse side for additional insUuctions and qualifiptions.
FORM 5
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Applicant (owner or oo ct buyer- see restrictions on 2 rs ide)
Taxing District Key number / legal description Record number Q I
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equRable
March 1, wrtent year March 1, currenl year owner? ❑ Yes ❑ No
SO 66U
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is d'rfferent than that of applicant, indicate below:
�e of mortgagee or contrad seller
Address of mortgagee or contract selier (number and stree ity, state, ZIP •
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaR � Yes ❑ No
� COUNTY AUDITOR
Deduction approved in the amount of:
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Sig Wre o C.� Counry Auditor Date
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- I� e certify under the penalty of perjury that the above and foregoing information is W e and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
i ture (owners name Person authorized by duty executed Power of Attomey
or by IC 61.1-12-.07
Fu esiden d ress o applipn ddress of author¢ed person
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