HomeMy WebLinkAboutMortgage_Shelton�<��•�•a STATEMENT OF MORTGAGE O CONTRACT Filin fee $1.00
a��°:; `; INDEBTEDNESS FOR DEDUCTION F County Township Year
=� ' VALUATION State Form 43709 (1-90) Prescribe y the
� State Board of Tax Commissioners �
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where ihe
property is located during the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
or contract buyer T
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Record No.
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AUDITOR
\� C�,l$�A O� 1 11 Page No.
Assessed value of real property as Mort age/Contract Indebte ness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
ao- 5 a� o
If no, what is his/her exact share or inierest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of
contract seller
h
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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
�%�
Signature
19
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19��
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Board of Review
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Date
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appii
�� was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
atu�rj (owners funll, name) Person authorized by duly executed Power of Attorney or
X �S � e X�1 _ i L by IC 6-1.1-12-.07).
Address of Aplicant � Address of Authorized Person