HomeMy WebLinkAboutMortgage_Taylor (9)��"��` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f--.. : FOR DEDUCTION FROM ASSESSED VALUATION
',, � S�ate form 43709 (R / 72-99) �
�u.
� Prescribed by State Boartl ot Tax Commissioners — _
InsUuctions for filing:
To be filed in person or by mail with the County Auditor of the co�..�y�� �Nerty is
located during the 12 months before May 11 of the year the deduction is t� ,� tive. See
reverse side for additional instructions and qualifications.
Applicant (owner or contract buyer
District
tions on reverse side)
i
Key number egal description
Assessed value of real property as of Mortgage / Contrad ii
March 1, current year March 1, current year
b(oi
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
`lame of mortgagee or contract seller s
� iC �`--(`�1 � Q a�
Address of mortga e�or contract seller (number
Name
Address
or other owner or holder of mortgage
FORM 5
fEB 16 2001
Record numb�
Page number
s unpaid as of Is ihe ap�
, owne(?
! tll� soleTgal or
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
city, state, ZIP
and street, city, state, ZIP code) _. --
� � ��
� �
Does applicant own real propeRy in any If yes, what county? What i� �""' ��+""' ��• ��t/�)c � ested on
other county in Indiana? " �'es❑ No
Deduction
j�'���lu;oee� 3,y�. oa
PROPERTY TAX ASSESSMENT E
amount of:
�S I������� zd'�2
Signature e U
r� / �i
Seaetary of PTABOA
20 D (0 20
�
� �� �
I/ We certify under the penalty of perjury that the above and foregoing information is true and correIX and that the applicants was /were
resident of Indiana and owner of the aforementioned property on March t, 20
iignat re ow rs full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
r ide address appiicant _ � Address of authorized person