HomeMy WebLinkAboutMortgage_Yeryar (3)f•�•na STATEMENT OF MORTGAGE OR CONTRACT
�t" .� .
?�, :� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
' VALUATION State Form 43709 (1-90) Prescribed by the
'' �` State Board of Tax Commissioners
�
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 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
(Owner or contract buyer
see restrictions on
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i _i.
Record Nd�UDITOR
' �`�� age No.
Assessed value of r I property as . Mortgage/Contract Indebtedness unpaid Is the applicant the sol legal or
of March 1, current year as of March 1, current year. equitable owner? es O no
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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:
N me of rtgagee or contract
�
Address of mort ee or
/
Nam of Assignee or other own
Address ot Assignee
or holder of Mortgage.
Does applicant own real property If yes, what county. What Taxing District. Has this deduction been
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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:
19� 19�/4-,Y. 19 n� 19 C0�- �QQ'�t�v�/Z
.�/4� ,oAOt' �S �-,11-6� /-a� o/
Signature � ✓ � Secretary of Board of Review Date o
�- 30-9� �o�.0 . �ao� �������-� a6B�`� J
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
r was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
:�eture (owners full n me) Person authorized by duly executed Power of Attorney or
I`'v�/_ ���/, _ ti by ic s-i.�-i2-.o��.
of
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Address of Authorized Person