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STATEMENT OF MORTGAGE
INDEBTEDNESS FOR DEDUCTION
VALUATION State Form 43709 (1-90
State Board of Tax Commissioners
OR CONTRACT
FROM ASSESSED
) Prescribed by the
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.
y0'� 3 � 1999
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Applicant (Owner o contract bu er - see restrictions on revers )
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Taxing District Key Number/Legal Descripiion Record No.
Q - c - Page No. _ �
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Assesse alue o al property Mortgage/Contract Indebtedness unpaid Is the applicant the sole lega or
of March 1, current year as of March 1, current yea� 0 3�� ��, equitable owner? O yes I7 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 mortgagee or contract seller _
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Address of mortg ee 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? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 19��_2 a9twa-o3 �Oo� 19� Y3' '�O(� 1.9�,:l1)D�
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Signature _ Secretary of Board of Review Date
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appii-
�ts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�nature (owners full name) Person authorized by duly executed Power of Attorney or
' by IC 6-1.1-12-.07).
Full esident Address of Aplicant Address of Authorized Person
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