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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 fil�d in person or by mail with the County Auditor of the county where the
property is located during the 12 mor;ths before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
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�AUDITO_ Ra-�3
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Towns
OCT 151996
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Year
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Applicant (Owner or contract buyer - see restrictions on reverse)
Taxing District K umbedLegal Description Record No. � �s
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole ega or
of March t, current year as of March 1, current year. equitable owner? O yes ❑ no
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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 mortgage r contract seller
Address of mortgagee or contract s�
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
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 O no
COUNTY BOARD OF REVIEW AVTION
Deduction approved in the amount of:
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Signature m Secretary of Board of Review D� � a p0 r�`�
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IlWe certify under penalty of perjury ihat the above and foregoing information is true and correct and that the appli-
5 was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
gn ure (owners full n e) Person authorized by duly executed Power of Attorney or
� ' SR. by IC 6-1.1-12-.07).
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Full Resident Address of plicant Address of Authorized Person