HomeMy WebLinkAboutMortgage_Bracher (3),�°`•�F� STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
��i � INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
VALUATION State Form 43709 (1-90) Prescribed by the
'�J ` State Board of Tax Commissioners
� � � � File Mark� -.
Instructions for filing: �� ����_i ' .
To be filed in person or by mail with the Couniy Auditor of the county where the �! J�.,
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. i���l Q; 1999
Applicant (Owner
District
buyer - see restricti ns on reverse) /'�"`,"`"""�'zi�;"`�"�`r
C HSO?� -. . . `[: .
i
Key Number/Legal Description Record N.
�O(c -� n�] ���-05 Pa9e No � .
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is (he a ica�e sole legal or
of March 1, current year as of March 1, current year/.� equitable owner? O yes � no
I A � � / / � � -
If no, what is his/her exact share or interest?
If 6wned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of mortqaqee or contract sel
or contract seller
Name of Assignee or other owner or holder
Address of Assignee
Does applicant own real property If yes, what county. What Taxing District. Has this deduction been
� o
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:
1
Signature
,9�oz �
f S L'1 ��ol I.
�•
o�
Secretary of
19
a5
of Review ! Date
. . ,..
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
� a re (ow rs full n Person authorized by duly executed Power of Attorney or
n�� ��... ��. A �� n� ) by IC 6-1.1-12-.07).
of Aplicant ��.���oK I Address of Authorized Person