HomeMy WebLinkAboutMortgage_Short (2)E•��TM4 STATEMENT OF MORTGAGE OR CONTRACT
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a�a y°s INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
•- ' VALUATION State Form 43709 (1-90) Prescribed by the
�• ' State Board of Tax Commissioners
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FORM 5
Filin fee $1.00
County Township Year
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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.
�,`i Z i �r�]Mark
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Appiicant (Owner or con�act�uyer - see r�`e3tric ions on�r`everse) .
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Taxing District Key NumbedLegal Description Record No. �
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Assessed value of real �property as •Mortgage/Contract Indebtedness unpaid Is the applicant the sole legai or
of March 1, current year� ' as f March 1, cu�renty�a�. equitable owner? O yes O no
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If'no, what is hislher exact share or interest? �' if owned with someone other than spouse,
indicate with whom.
If name on record is differen4 than that of applicant, indicate below: .
�e of mortgagee or contract seller � — 1
Address of mortgagee or contract seller � �
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee .� � a G , a _ � ► - . .
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 rJ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year j2�— 'FB�� �� Y�r�� Year � Year � Year � G Year :%n ��
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Signature arj Secretary of Board of Review Date
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I/We certify under penalry 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,
Si at re wners_full name) (� Person authorized by duly executed Power of Attorney or
� � •i by IC 6-1.1-12-.07).
Full esident Address of pplicant Address of Authorized Person
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