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Mortgage_Angermeier;.���a� STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00 `; '� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED a ,. r, �� � �� VALUATION State Form 43709 (1-90) Prescribed by the County Township Year ,`�% State Board of Tax Commissioners " � � ,. File Mark Instructions for filing: To be filed in person or by mail with the County Auditor of the county where the ���� � / property is located during Ihe 12 months before May 1 1 oi the year the deduction /� is to be effective. See reverse for additional insiructions and qualifications. (,JAN - 7 1994 Applica t Owner or act buye - s restrictions,on reverse) ,li. �r�t'� AUDITOR Taxing Dist ct Key mber/Legal D scription Record No. 5-03-/b� . �� iS-3-� a ��• Page No. ��J Assessed va e of r I property as Mortgage/Contract Indebtedness unpaid Is the applicant ihe sole legal or of Mar¢h,t, cur�reltOyear as of March 1, current year. equitable owner? O yes O no `.f � 5 � If no, what is hislher exact share or interest? I( owned with someone other than spouse, indicate with whom. If name on record is diiferent than that of applicant, indicate beiow: Nal^�•of morigagee or contract seller . Address of mortgagee or coniract seller Name of Assignee or other owner or holder of Mortgage. Address o( Assignee Does appiicant 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? ❑ yes O no COUNTY BOARD OF REVIEW ACTION Deduction approved in the amount of: 19��- _� 5 199 � 19�' —p� 19 19�� P�_p3 �90e - c y - -DI f�BDA Signature 09'� _ Secr tary of Bo rd o( Review Da (� j�COG �Dfl % �-� 9- 9� �.��, �-ABo�a �l<<fa 9 �P � ° IIWe certify under penalty o( perjury that the above and foregoing intormation is true and correct and that the appli- ca � vaslwere a resident of Indiana and owner of the a(orementioned property on March t. 19 Sig�� i e(owners full name � Person auihorized by duly executed Power of Attorney or r["' � by IC 6-1.1-12-.07). V� Fu I Re ent Address of Aplican Address o( Auihorized Person �� 1 C/��UaS Ow��,'l� �l G�>�5��s i�'