HomeMy WebLinkAboutMortgage_Wildt (5)E•�°•a STATEMENT OF MORTGAGE OR CONTRACT
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a��°:� ` INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
= '' VALUATIOfd State Form 43709 (1-90) Prescribed by the
e State Board of Tax Commissioners �
'�
Instructions for filing:
To be fil.�d 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 effective. See reverse for additional instructions and qualifications.
Applicant (Own or contr ct bu er - see restriction on reverse)
Taxing District Key Number/Legal Description Record No. �
� d lCJ �3 fJ! �(� Page No. 'y
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 rJ no
�
If no, what is hislher 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 ^
/.l ���..
lXJ � �' �
Address 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? ❑ yes O no
COUNTY BOARD OF REVIEW Ai,TION
Deduction approved in the amount of:
19� 19g�-ea 19� I 19��- � 19 t9'�o
� u a- 5 �.-a�_6� `-a�_ oi �pQ�4--
Signature Secretary qfo�d of�i�w �t� .. o� 0�
6- 30 -98� ,Z3 �- � . °� �° �
I/We certify under penalty of perjury that the above and foregoing inf6rmation 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
a� ature (owners f I n�� ��/�G� Person authorized by duly executed Power of Attorney or
��� by IC 6-1.1-12-.07).
F Resident Address of Ap cant Address of Authorized Person