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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 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 ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
(Owner or co
District
- see restrictions n reverse)
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Key Number/Legal scriF
Filin fee $1.00
>unty Township Year
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i� 1',Fjle: Mark �
Fc6 11 1999 �
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GIBSO;.
Record No. �
- �a � Paqe No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March t, current year as of March 1, current year.� equitable owner? O yes � no
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:
agee or contract seller
Address of mortgagee or contract
Name of Assignee or other owner or holcJer of Mortgage.
of Assignee
Does applicant own real property I If yes, what county? I 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:
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Signature
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Secretary of Board 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 appti-
�nts was/were a resident oi Indiana and owner of the aforementioned property on March 1, 19.
aign�(ure (owners full name) Person authorized by duly executed Power of Attorney or
� j/ . . �_ by IC 6-1.1-12-.07).
Address of Aplic�lt � Address of Authorized Person