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,�.^p4y STATEMENT OF MORTGAGE OR CONTRACT
a�sy : INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
' VALUATION State Form 43709 {1-90), Prescribed by �the
. State Board of Tax Commissioners
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Filin fee $1.00
County Township Year
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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. F� 3 l, 199� ��
Applicant
District
or contr ct b er - se� re t ic onS on r
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Key Number/Legal
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escriptio Record No I
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Q�
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the s
of March 1, current year as of M h 1, current year. equitable owner? - yes O no
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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:
Address
Name
mortgagee or contract
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 19 9� 19�-Q0 19�� 19_��I�.
�i�l�' ,t3 s c�i g' °�
Signature Secretary of Board of Review
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certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
� was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
itu rwners full name) Person authorized by duly executed Power of Attorney or
y�� � � . by IC 6-1.1-12-.07).
of Aplicant
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Address of Authorized Person