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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
Instructions for filing:
To be fi�ed 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 efiective. See reverse for additional instructions and qualifications.
Filinq fee $1.00
File Mark —""
NOV 10 1998��
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GIBSON „p��,frv qUDITOR
Appiica Ow er o contract b y - see restrictions on reverse)
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Taxin District Key Number/Legal Description Record No. �
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Assessed value of real roperty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Mar�h;�c�re_nt year. ,�D equitable owner? O yes O no
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If no, what is hislher 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:
��e of mortgagee or contract seller (_ L„ n
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Address c?f mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District7 Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes rJ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Si nature Secretary of Board of Review Date
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IlWe 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 .
Si�at o rs full na ) Person authorized by duly executed Power of Attorney or
/' �'�,�� by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person
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