HomeMy WebLinkAboutMortgage_Bedwell (2),��•�a STATEMENT OF MORTGAGE O ONTRAC
a�a:� ` INDEBTEDNESS FOR DEDUCTION FR D
�� ' VALUATION State Form 43709 (1-90) Prescribed by the
-�.e•` State Board of Tax Commissioners
Instructions for filing:
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 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
or Fpntract buyer - see restrictions on
Taxing Distric�/ Key Number/Leq3fVDesci7ption
o�c�-o���33-�0
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Filin fee $1.00
County Township Year
�
File ��I� � O 19�
� �', �`
� AUDITOR��
P�rl�
.. .
No.
rn
Assessed value of real property as Mortgage/Contract Indebtedness unpaid I Is the applicant the s le legal or
of March 1, current year as of March 1, current year. equitable owner?�es O no
I 2/1!1_ ��."�T �� /1/i%i
If no, what is hislher exact share or interest?
If name on record is different than that of applicant, indicate
or
�oC1��Q � • °�
mortgagee or contract
Name of Assignee or other owner or
Address
If owned with someone other than spouse,
indicate with whom.
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? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19��� I1
19�00 �9�� 19� � �� �O'D
;11�1ca rao�r � . , � �f� � , �,o, o /��i�
Signature Secre4ary of ^Boa�r of Review Daf �� o�
6 - a 9- 9P ,f3• o-� �P. �6 �yf� � � � � �T
��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
r , was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
� �a^ture (owners full name) Person authorized by duly executed Power of Attorney or
V=., (�_ ___ CJ..,_. D. 2aOn by IC 6-1.1-12-.07).
Resident Address of Aplicant Address of Authorized Person
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