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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Filin fee $1.00
Countv Township Year
File Mark
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 �1J
is to be effective. See reverse for additional instructions and qualifications. ��
MAY 7 1992
Applicant (Owner or coniract
`
- s�restrictions
. < _
AUDITOf2 �'��
Record No.
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Assessed value of real pfoperty as Mortgage/Contract Ind�bt�s���"paid Is the applicant the sol egal or
of March 1, current year as of March 1, current year. equitable owner? es O no
a �'ao
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:
or contract
0
seller
Name of Assignee or other owner or
ee
Mortgage.
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�
0
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:
i
Signature
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� s���, r,��a_�o8 � te- U.� �s-�
.�g-bl -d�o-o�--
_ Secretary of Board of Review Date � �7o� �
6- �� -9� �3-��.. �i �B�y °2�° 1� �
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 1, 19
ature (owner full name) Person authorized by duly executed Power of Attorney or
����1% � _ ��.�� by IC 6-1.1-12-.07).
Full
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of Aplicant
Address of Authorized Person