HomeMy WebLinkAboutMortgage_Scamman�`�p4` STATEMENT OF MORTGAGE OR CONTRACT
a�. y INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
` VALUATION State Form 43709 (1-90) P�escribed by the
���e, 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'additionai instructions and qualifications.
FORM 5
Filin fee $1.00
County Township Year
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JUNF'� ��i �
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Appli t(O ner or con ract buyer - ee restrictio n reverse) ,
Taxing District Key ber/Legal Description Record No. O-
f��G��W✓�`' �l'VO / Y��v Page No. ,j 3 7
Assessed value of real proPerty as Mortgage/C ntract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Mar , c ent year. equitable owner? O yes O no
Q��
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:: • __ • -
?��e of mortgag�e or contract seller
Address of 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? J yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year ��— 1`�j� -4.� Year %�_? Year � Year,.2QQ� Year -�o • Year �
5 -I -�l . .01 � P
Signature Secretary of Board of Review Date
T �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
�licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
� S� nature wners full name) Person authorized by duly executed Power of Attorney or
�� by IC 6-1.1-12-.07).
Full Reside Address of Applicant Address of Authorized Person
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