HomeMy WebLinkAboutMortgage_Phelps (2).n^•4 STATEMENT OF MORTGAGE OR CONTRACT
a� A` INDEBTEDNESS FOR-DEDUCTION"FROM ASSESSED
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�� 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 where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
FORM 5
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Applica t( wner r cnntract buye - see rest tions o r verse)
Taxi District Key umbedLegal Description ecord No. .
� Page No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the aPplicant the sole legal or
of March 1, current year � as of M rch 1, current year; ��� � equitable owner? O yes O no
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If no, what is his/her exact share orinterest? 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 of 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
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:
Year � Year �r Years��,C, Year � Year Year�d�2'� Y.ear o�-u0 6
5%'a°��� ' 6'�Z �T'aiBOl9 P
Signature 6� � Secretary of Board of Review Date
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
ignatur (owners fuil name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
F esident Address of Ap lic t Address of Authorized Person
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