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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
fee $1.00
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county whe �
property is located during the 12 months before May 11 of the year the deduction � �ggg �
is to be effective. See reverse for additional instructions and qualifications. �QV 1 n ��
(Owner or
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;t buyer - see restriciions on reverse) ,�-G""- r`our' '
�a GlBSON �
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ey Number/Legal Description Record No.
� O O�— O � 73 jl �d paae No.
Assessed value of real pro}�erty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March(I�current year. equitable owner? � yes � no
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If no, what is his/ er exact share or interest? If owned with someone other than spouse, .
indicate with whom.
name on record is different than that of applicant, indicate below:
of mortgagee or
of mortgagee or contract
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or other owner or
Address of Assignee
of Mortgage. �
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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:
19 D 01 ��
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-02
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Secretary of Board of Review ; Date
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certify under ty of perjury that the above and foregoing information is true and correct and that the appli-
wa a re�siden f Ind r of the aforementioned property on March 1, 19
i ure (o is full n /_ �� Person authorized by duly executed Power of Attorney or
� _�_N_ e. �� � � Y IC 6-1.1-12-.07).
Address of
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Address of Authorized Person