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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 ffling:
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 /J
is to be effective. See reverse for additional instructions and qualifications. �---� y�,���%
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GIESO4'�C,,�.�-Y AUDITOR
FEB 0 3 2000
Ap cant ner or contrac uyer - see restriction o rev
Tax'ing D trict Key Number/Legal Description Record No.
0�� 0O �l� �� Page No. T �
Assessed value of reai property as Mortga e/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of� h 1, current yea���pp� equitable owner? � yes 7 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:
Name of mortgagee or contract seller
Address of mortgagee or contract se ler
Name of Assignee or other owner or holder of Mortgage.
d_/.�0/
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has this deduciion been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19—n�9'a 19�.?. � -83 �_Q.Q� - p � 1 19 !� y8' .2 ° � 4
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Signature _ Secretary of Board of Review Date
�OD?—� DY- �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�ts waslwere 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).
F esident Address of Aplicant� Address of Authorized Person
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