HomeMy WebLinkAboutMortgage_Tharp.�•n4 STATEMENT OF MORTGAGE OR CONTRACT
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a�. '� INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
' VALUATION State Form 43709 (1-90) Prescribed by the
'' .• ` State Board of Tax Commissioners
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a.w-,o..�.ed 3— y —��i
Instructions for tiling: APR O 6 19�e Mark
To be filed in person or by mail with the County Auditor of the county v��here th �
property is located during the 12 months before May 11 of the year the deducti �—,�
is to be effective. See reverse for additional instructions and qualifications. Giasow �J��� TV AUDITOR C� '/
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Applicant (Sl�rner or
District
- see restrictions on
Key Number/Legal
Record
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Assb�s ed value of real property as Mortgage/Contract Indebtedness unpaid Is th'e applicant the sole legal or
of March 1, current year as of March 1, current ear. /oo oo° equit��ble owner? O yes j
If no, what is hislher 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:
mortgagee or contract seller
Address c?f mortgagee or contract seller
Name of Assignee or other owner or holder oi Mortgage.
Address of Assignee
Does applicant own real property If yes, what county?
in any other county in Indiana?
COUNTY BOARD OF
Deduction approved in the amount of:
7 9 �jl/"�Dll I 19
Signature �/f!�
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2009
ion been
operty for current
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Secretary of Board of Review Date
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IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
's was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
S� ature (owners full name) Person authorized by duly executed Power of Attorney or
�Sl c T/ _ n by IC 6-1.1-12-.07).
Address of Aplicant I � Address of Authorized Person