HomeMy WebLinkAboutMortgage_Hape,.��`"'FQ STATEMENT OF MORTGAGE OR CONTRACT
;�� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
/:�` VALUATION State Form 43709 (1-90) Prescribed by the
�. State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with ihe 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.
Applicant
District ,
contract b�yer -
Key Num
on reverse)
3�1 Description
- oo�sy
Filin fee $1.00
County Township ear
a r.
File Mark
. APR 22 1999�
/^'
G/� �g$pt, �, j;�AUD� �
Record No.
rvo. �-/'7,
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Mar�h 11current year. equitable owner? O yes � no
lD� , iTn�
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:
of mortgagee or contract
of mortgagee or contract
Name of Assignee or
of Assignee
owner or holder of Mortgage.
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? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�Da 19 1 19_�p_� ��jp,q_o3
,� n.� � e S L•,21 _ o � y�,�,/D
Signature
a ��
oy
of Board of Review
,
Date
����1��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
`�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
gn ture (owners full name) Person authorized by duly executed Power of Attorney or
syjl �� ��/ _ by IC 6-1.1-12-.07).
Resident Address of
of Authorized Person