HomeMy WebLinkAboutMortgage_Kiferrr�•�4 STATEMENT OF MORTGAGE OR CONTRACT
a�-=:; ` INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
` VALUATION State Form 43709 (1-90) Prescribed by the
,���e. 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
property is located during the 12 months before May 11 of the year the deduction
Filin fee $1.00
County Township Year
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APR 28 iy��
is to be effective. See reverse for additional instructions and qualifications. " �
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Ap ica (Owner r co ra bu r- s restric ons on reverse) ' `{ cot�r�,-v ��� �"�
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Taxing District umber/Legal Description Record No.
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of M�LGh 1 current year. $��oo equitable owner? O yes ❑ no
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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:
��me of mortgagee or ntr ct seller
Address ef 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 ACTION
Deduction approved in the amount of:
19� 19�7- oa 19 19�bD1 �._�� � _1.8��3 19
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Signature Secretary of Board of Review Date �� �Q
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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-
'"� 's was/were a resident of Indiana and owner of the aforementioned property on March t, 19
,� � ure owners f II na e) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
ull esident A�idr�ss of pli nt ^ Address of Authorized Person
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