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,Es•.�a STATEMENT OF MORTGAGE OR CONTRACT
ai�°:� `, INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
��� VALUATIO� State Form 43709 (1-90) Prescribed by 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 the
property is located during the 12 morths before May 11 of the year the deduction
is to be efiective.. See reverse for additional instructions and qualifications.
ny(vwner or c nt
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District
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see restrictions on reverse)
Key Number/Legai Description
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Filin f�e $1.00
County Township Year
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Ji;iv 0 � i998 �
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Record No.
Pape No.
Assessed value of real property as Mortgage/Contract Indebtedness 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
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 mortgagee or contract seller
Address of mortgagee or contract seller
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Name of Assignee or other owner or holder of Mortgage.
Address of Assiqnee
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Does applicant own !eal 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:
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ure _
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_ Secretary
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Board of Review
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Date
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I/We certify under penatty of perjury that the above and foregoing information is true and correct and that the appli-
�ts was! re a resident of Indiana and owner of the aforementioned property on March 1, 19
natur ne full �me) Person authorized by duly executed Power of Attorney or
� � � by IC 6-1.1-12-.07).
of Aplicant � Address of Authorized Person
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