HomeMy WebLinkAboutMortgage_Rinsch.n�TM4 STATEMENT OF MORTGAGE OR CONTRACT
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a�=:� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
=`�a' VALUATION State Form 43709 (1-90) Prescribed by the
� ��. State Board of Tax Commissioners
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Instructions for fiiing:
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 eifective. See reverse for additional instructions and qualifications.
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nFile Mark
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AUDITO
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Applicant ( wner or cont�act buyer - see restr(ic�tions on reverse)
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Taxing District K� NDm �r/Legal Des�i�tion Record No. � C}a
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��I Ci"r�r� 5 C.v a-a- � �.� age No. ��
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the so I or
of March 1, current year as of March 1, current year. equitable owner'?�yes O 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:
�e of r�ortgagee or cont act seller -
f 1
Address of mortgagee or cont�act 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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 9� 19 L l-O o 19 � 19.�_b Q�, � b 0�� 19�U 19
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Signature Sgc_ratary of Boar� 6 e�w �D,aDt� Q� � o�i
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(o - �O-`3�l � � i( . ��}[30�@' .-� � i
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
� nature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident ddre,s� of A�pplicant Address of Authorized Person
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