HomeMy WebLinkAboutMortgage_Richardson (11)�rt�° � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�=�: : FOR DEDUCTION FROM ASSESSED VALUATION
'> > State Form 43709 (R / 12-99J
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� PrescnOed Dy State Board of Ta�c Commissioners
InsVuctions 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 lhe year the deduction is to be effective. See
reverse side for additional instruclions and qualifications.
Applicant
Taxing
or cont2ct 6uyer-
Assessedvalue of real property as of
March t, current year
If no, what is his / her exact share of interest?
re�erse side) ,
Key number / legal description
FORM 5
MAY 0 7 Z001
number
Q I 1_ OoI r,�_� Page number �,y ��
b �f Y�
MoAgage / Contrad ihdebtedness unpaid as of Is the applicant the sole legal or e
March t, current year � ownef? ❑ Yes ❑ No
U q r:�q.8�
� If owned with someone other lhan spouse, indicate with whom.
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If name on record is different than that of applicant, indicate below:
mortgagee or contred seller
Address of mortgagee or contracl seller (number and street, cilk� state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (numbe� and st2et, city, state, ZIP
Does applicant own real propeRy in any If yes, what county? What Taxing District? Has lhis deduction been requested on
other county in Indiana? property for current year? � Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
)eduction approved in the amount of:
20 �j� 20Q�(j3 D 20
� l.-ll-bl l.•�H-o�- V �
2o U ` 20
� �
Seuetary of PTABOA
20
Date
`+ I ZO �
P
� / I
/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
I re ' ent of Indiana and owner of lhe a(orementioned property on March 1, 20
�gnaWre (owners full name) Person authorized by duly executed Power of Attomey
� -- - �, � - Q - (� ' , or by IC 6-1.1-12-.07
ofauthorized person