HomeMy WebLinkAboutMortgage_Dekemper,a""'� STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION Siate 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 quatifications.
Filin fee $1.00
County Township Year
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Applican Owner or contract buyer - see restriction� n everse) �.: ���n C::_�r:?v �.;;p!;p�
Taxing District Key Number/Legal Descriptio Reco No. Op
— Q •QZj Page No. � � �
Assessed value of reai property as Mortgage/Contract Indebtedness unpaid Is the applicant ihe sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes � 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:
Name of mortgagee or contract seller
Address of mortgagee or contract s ler
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 � no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�.�1`� �s�bD�, �db3,-'9�Q 49'�.� �.2�� a9"��d°S'� 1.�a�CP
d" ��� SG-2�-oi 4�-0�. � � `1�
Signature 0� CS2Z D� _ Secretary of Board of Review 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 appli-
�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
��nature (owners full nam� Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident Address o Aplicant Address of Authorized Person
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