HomeMy WebLinkAboutMortgage_Tenbarge (11)f•T�TM4 STATEMENT OF MORTGAGE OR CONTRACT
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a��° �°- INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
" ' VALUATION State Form 43709 (1-90) Prescribed by the
�� State Board of Tax Commissioners
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Township I Year
File Mark— �
Instructions for tiling: JUN 2 6 1996 �
To be filed in person or by mail with the County Auditor of ihe county where the
property is located during the 12 months before May 11 of the year the deduction �,,,�,,,�� �,' �'�,,t,�
is to be effective. See reverse for additional instructions and qualifications. AUDITOR �
Ap � nt (Owner or contr c buyer - e restr ctions on reverse) .
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Taxing District Key Number/ e I Description Record No. i�
�,� - o�e a�
� � �, - �{- I �. �� age No. �O .
Assess value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sol legal or
of March 1, current year as of March 1, current year. equitable owner. es ❑ no
S e�
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:
�e of mortgagee or contract sell r ��
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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19� 1��U9 19 � 19�� �I�-°3 ,�8�� �� 19�
/a3��ri�'i . g.ol G- �S-a3 �i ih
Signature Secretary of Board of Review Date
<v- ��G-g8 �3���• � .p� oF��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
waslwere a resident of Indiana and owner of the aforementioned property on March t, 19
Si nature (owners full name) Person authorized by duly executed Power of Attorney or
� by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person
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