HomeMy WebLinkAboutMortgage_Evans (2)FORM 5
o�:R�pae STATEMENT OF MORTGAGE OR CONTRACT
Filin fee $1.00
,�. ;; INDEBTEDNESS FOR DEDUCTION FROM ASSESSED ._ Count � Townshi Year
��' VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
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Instructions for filing: $EP 1 ��L�QBark
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 additional instructions and qualifications. GIBSON CoUN7Y AUOI70R
Appli an ner or uyer - see restrictions on re rs )
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Taxing District y NumbedLegal Description - Record No G�
Q� % " � � o � �J ' � Page No. 3 3 � �J
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, currenl year as of March 1, current year. " equitable owner? O yes O no
o /�/i �� oo d
If no, what is his/her exacfshare 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 mortgagee or contract seller r h �. �/
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Address of mortgagee or contract seller �
- . -- d
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee - •- �
Does applicant own !eal 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 O'. Year b Year�D 3 Year IL'� Year O Year d Year � 7
, b� �CJ P
Signature �o � � Secretary of Board of Review Date
N �S � O- 3-/ /y
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,
�
gnature (owners full name) Person authorized by duly executed Power of Attorney or
� � �— by IC 6-1.1-12-.07).
F I Resident Address of Applicant . Address of Authorized Person