HomeMy WebLinkAboutMortgage_Dewig (3)��•�• STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
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�3�^y `• INDEBTEDNESS FOR DEDUCTION FROM ASSESSED�
VALUATION State Form 43709 (1-90) Prescribed by the County Township Year
r' r��,• `�. 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 v��here the ��' i
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. �`( 2� �99�
or
s�e restrictions on reverse)
Taxing District 44ey Number/Legal Description
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Record No.
No.
Assessed value of reai 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 ❑ no
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If no, what is his/her exact share or interest? If owned with someone other t i
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
of mortgagee or contract se
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Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
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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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19��00 I 19
Signature '
•�O��f p� �069
1
I/We certify under penalty of perjury Y�
�s was/w�re a reSi�ent of Indiana
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Secretary of Board of Review
Date
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above and foregoing information is true and correct and that the appli-
vner of the aforementioned property on March 1, 19
Person authorized by duly executed Power of Attorney or
��� y IC 6-1.1-12-.07).
Address of Authorized Person