HomeMy WebLinkAboutMortgage_Peters�.^•^v STATEMENT OF MORTGAGE OR CONTRACT
�i •": INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
'T�' 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 the year the deduction
Filin fee $1.00
County Township Year
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is to be effective. See reverse for additionai instructions and qualifications. //1 I��O 5 1998 \��
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Applicant (O r or contr t er - see restrictions on reverse) `'� `"°�' Y �`�'�!70R
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Tax g Dis rict Key Number/Legal Description Record No. �j
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Assessed value of real property 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? O yes ❑ 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:
�me of mortgagee or contract seller . ^
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Address c?f mortgagee or contract seiler
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does appiicant own real property If yes, what county? What Taxing Disirict? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY. BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature Secretary of oard of Review Date
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I/We certif under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�ts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�gnature (owners full name) 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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