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n•n STATEMENT OF MORTGAGE OR CONTRACT
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a�. ti INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
���e' VALUATION State Form 43709 (1-90) Prescribed by the
, s�• State Board of Tax Commissioners
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Instructions for filing:
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.
APR 29 i°`:r ` �
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�AUDITOR
Applicant (Owner o contract buyer - s e estriction o reverse)
Taxing District Key Number/Legal Description Record u �
M �,,.-Q� I l•3-I� lu•A� r�
�-� l�/��� 9•�� ,�O.AC. PageNo. Gr �0� �1��
Assessed value of real property as Mortgage/Contra t ndebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1,.current year. equitable owner? O yes ❑ no
�
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:
-�e of mortgagee o contract seller �
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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:
is 9b' �s��—a� is is D�B� �0�3 ��ey �'
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Sig�a�ture Secretary o� a� of Review Date �FTa� �bo7
� � - �- � -98 �. � � • �r�� � l�6 P
I/We certify under penalty of perjury that the above and foregoing information is true and.correct and that the appli-
- s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
Sign� re (owners full na Person authorized by duly executed Power of Attorney or
� . by IC 6-1.1-12-.07).
Full si ent Address of Ap icant Address of Authorized Person