HomeMy WebLinkAboutMortgage_Fichter�T.�• STATEMENT OF MORTGAGE OR CONTRACT
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a���=^ �`: 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
Countv Township Year
Instructions for filing: ���, � t�-�1 ��e Mark
To be filed in person or by mail with the County Auditor of the county where the �y O Q�19y�
property is located during the 12 months before May 11 of the year the deduction n (�
is to be effective. See reverse for additional instructions and qualifications. ((, x
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Applican (Owrner or contract b er -"se restrictions on evers . ��' `
Taxiy�7 District K Number/Legal Description Record No. G g
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Assessed value of real pro�erty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole Iegai or
of March t, current year as of March 1, current year. equitable owner? O 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:
�ame of mortgagee or contract seller
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Address of mortgagee or contract sell
Name of Assignee or other owner or holder of Mortgage.
Does applicant own real property If yes, what county. What Taxing District. Has this deduction been
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in any other county in Indiana? requested on property for current
year? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Secret of E
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I of Review Date
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
s as/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
��na e�(owne�ll n e)�� Person authorized by duly executed Power of Attorney or
,� l�Qt.a.�. � 4' by IC 6-1.1-12-.07).
�nt Address of Aplicant Address of Authorized Person
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