HomeMy WebLinkAboutMortgage_Miller (35)^•n 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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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county v��here the
property is located during the 12 months before May 11 oi the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant (Owner
Taxina District
- see estncuL��
ey Number/Legal
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GI�U TY AUDITOR
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Record No.
� Paqe No.
Assessed value of real prdperty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? ❑ 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:
of mortgagee or contract seller
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 District. Has this deduction been
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in any other county in Indiana? requested on property for current
year? ❑ yes rJ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Secretary of Board of Review
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Date
���199
I/We certify uniier penalty of perjury that the above and foregoing information is true and correct and that the appli-
r `5 was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�,ynature (owners full name) Person authorized by duly executed Power of Attorney or
\/ �,{1 ' . _ . �_.F�,. ' „ . _ , by IC 6-1.1-12-.07).
Address of Authorized Person