HomeMy WebLinkAboutMortgage_Devischeybergen,,E�=•_:,•a STATEMENT OF MORTGAGE
���a:� ` INDEBTEDNESS FOR DEDUCTION
` VALUATION State Form 43709 (1-90
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e State Board of Tax Commissioners
Instructions for filing:
OR CONTRACT
FROM ASSESSED
) Prescribed by the
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.
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co ract buyenr - s�eefestr tions on rever e)
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Taxing trict Key Number/ gal escription Record No.
61� — 00�5 8 0� 0
Page No. 3
Assessed value f rea roperty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year � as of March 1, ^c�urrent year. equitable owner? O yes ❑ no
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If no, what is hislher exact share or interest? If owned with someone other than spouse,
indicate wiih whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee 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? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
199s-9% 19� 19��-Cj'� 19 19�dh`�/ �(j�D3 �J6�-o�/
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Signa�jure ° Sec tary of B ard of Review Da�[e b �G%
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�bp� (� � /9—S� '�.�• ��• Pazl�
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
� was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�g� atur (owners full name) Person authorized by duly executed Power of Attorney or
�J��� • by IC 6-1.1-12-.07).
Full Resident Address of Aplic Address of Authorized Person
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