HomeMy WebLinkAboutMortgage_Holt�..T*p4, STATEMENT OF MORTGAGE OR CONTRACT
a�..y 4 INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
� a' � VALUATION State Form 43709 (1-90) Prescribed by the
� �• '� 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.
Applicant (Owner or
District
m
see
; Key Number/Legal Description
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FORM 5
fee $1.00
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Record No.
No
APR 2 � 2000
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2� QS
Aasessed value eal'property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, curr t year as of March 1, current year. equitable owner? O yes O no'
Co (ooe�
If no, what is his/her exact share or interest?
If owned with someone other tfian spouse,
indicate with whom.
If name on record is different than that o.f applicant, indicate betow; .._
��e of mortgagee or contract
Address of mortqaqee or contract
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee � '
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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? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year�� Year ��' Yeaf�'� ( 1�^bji�
Signature�'�7—�P b 8— /° v�i— p Secretary of Board of Review
Year
Date
Year o0
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,
nature (owne{s full name)
Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
II Resident Address of Applicant Address of Authorized Person
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