HomeMy WebLinkAboutMortgage_Henryf.^P4� STATEMENT OF MORTGAGE OR CONTRACT
a�. INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
' 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
District ,
�_
Assessed value of real property as
of March 1, current year
`� JUL 21 1998
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Key mberlLegal escri o Record No. �(?
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- � Page No. � l� oZ--
Mortgage/Con ract Indebtedness unpaid Is the applicant the sole legal or
as of Marc 1, current year. equitable owner? O yes O 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:
�ame of mortgagee or contract seller
Address 4f mortgagee or contrac Iler •
Name of Assignee or other o r holder of Mortgage.
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Does applicant own real property Ii 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:
�9�� DO 19 [
Signature�
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AapD�. e4
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P�Al3o�
of Board of Review Date
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I/We certify under penalty of perjury ihat the above and foregoing information is true and correct and that the appli-
��ts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
� gn�ajture (owners full name) Person authorized by duly executed Power of Attorney or
n7'�.�.,rIG ,�lln.�n�..,� byIC6-1.1-12-.07).
Full Resident Address of A�SHcant Address of Authorized Person
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