HomeMy WebLinkAboutMortgage_Raber��'"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s
'r--:. ;: FOR DEDUCTION FROM ASSESSED VALUATION
•> > S�ate Form 43709 (R / 72-99)
.�,• Presaibed by State Board ol Tax Commissioners
InsVuctions 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 side for addi5onal instructions and qualifications.
Applicant (owner or contract 6uyer- see
Taxing District
P�_��
Assessed value of real property as of
March 1, current year
If no, what is his / her exacl share of interest?
on reverse side)
Key number / lega`I description -�
oo� - c� i co �s - � _
Mortgage / Contrad fndebtedness unpaid as
March 1, current year S'� DO�
name on record is different than that of applicant, indicate below:
of moRgagee or contract seller
FORM 5
Filing fee 51.00
Coun Township Year
���a��
FEB 9 2001
GIBSON
d number
OI
number _ _
Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
of mortgagee or contract seller (number and st2et, city, state, ZIP
assignee or other owner or holder of mortgage
(num6erand street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has lhis deduclion been requested on
oiher county in Indiana? property for current yea(1 � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
amount of:
20 �'L
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Signature
a fi.
20 U 9 I 20
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Secretary of PTABOA
20
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/ We ceAify under the penalty of perjury lhat the above and foregoing information is Irue and corred and lhat the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
gna ers full na Person authorized by duly executed Power of Attomey
� Q, . .�o O o� by ic s-i.i-iz-.o�
Fap / Address of authorized person
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