HomeMy WebLinkAboutMortgage_Tipton`rt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�°- : FOR DEDUCTION FROM ASSESSED VALUATION
`> � State Form 43709 (R / 72-99)
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Prescribed by State Board of Tau Commissioners
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InsVUCtions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
localed during the 12 months before May 17 of ihe year the deduction is fo be effective. See
reverse side for additional instructions and qualifications.
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Assessed value of real property as of
March 1, current year
If no, what is his / her exacl
ofinterest?
name on record is different than that of
of mortgagee or contrad seller
Address of mortgagee or wntracl seller
Name
Address
on
Key nu�fib�F / legal
FORM 5
Record
APR 19 2001
�/ � ,P'�Q � �iD p�T Page number � O � 1
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Mortgage / Contred ihdebtedness unpaid as of Is the applicant the sole egal or equitable
March 1, current year ownef? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
or other owner or holder of morigage
below:
and stieet, city, sfate, ZIP code)
state, ZIP
-S3
Does appiicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yea(? � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
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amount of:
-bi I ��as-o2
20
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Seuetary of
20 �,,,� I 20 O o_ I 20
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I/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of lhe a(orementioned property on March 1, 20
'ig ure (owners lull nam Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
=ull resident addr s of licant Address of authorized person
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