HomeMy WebLinkAboutMortgage_Scott (7)E•�•••a STATEMENT OF MORTGAGE OR CONTRACT
� P
��°.q ' INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
" ' VALUATION State Form 43709 (1-90) Prescribed by the
' e'� State Board of Tax Commissioners
�
fee $1.00
Township
� � � j Fil��k
Instructions for filing: Y,� �yy�
To be filed in person or by mail with the County Auditor of the county N�here the �"�i
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications. /� ���� �. D
u. , . , r 7�`i'`'�y'��
�'C�?5��� �pi�, TY FUCITOR
Applicant�('O,�ner or
Tax
ee stricti s on reverse)
Key Number/Legal Description
C)''1/ _ � / �% �/ _ i
Record No.
iL�]
Year
Assessed value of real pd6perty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of M , current year. equitable owner? O yes ❑ no
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:
of mortgagee or contract seller
of mortgagee or contract seller
Name of Assignee or other owner or holder
Address
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:
� s� � � s�b o
Signature
��
�
, �o�
���,e
�n "ory/ ' a `3-
Secretary of Board of Review
�o_o�
,�-
Date . �_
�/9 j98
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
Signa (own�rs full e) Person authorized by duly executed Power of Attorney or
�( ,� �,�} ,_,� by IC 6-1.1-12-.07).
Full Resident Address of Aplicant
i��E,-%.�
f
Address of Authorized Person