HomeMy WebLinkAboutMortgage_Rybachek�1fsTp4 STATEMENT OF MORTGAGE OR CONTRACT
f INDEBTEDNESS FOR DEDUCTION FROM A$SESSED
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����40� VALUATIO�� State Form 43709 (1-90) Prescribed by the
-� �_� State Board of Tax Commissioners
Instructions for filing:
To be fii�d in person or by mail with the Couniy 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.
con a t
1 e. .
Taxing
AUG � 51997 ���
G?SSOti ..0.1: TY AUDITOR
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Key Nu ber/Legal Description Record No.
�� !"V1.�7�7�� PaaeNo.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Marc 1,�u9,r\re�n�y`ear. equitable owner? O yes O no
V W
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:
of mortgagee or contract seller
Address of mortgagee or contract seller
Name of Assignee or other owner or holder
Address of
age.
Does applicant own real property If yes, what county? What Taxin� District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
I�L� ' � + � �
Signaturg o
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19 60� �a3
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V1. Secretary of Board of Review
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1�00?-eY b8��
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Date �5�p
lp;/�cl'� /
I/We certify under penalty of perjury that 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
��yna/t�ure (owner full name) � Person authorized by duly executed Power of Attorney or
V 1 i rn ��4 �� i�'Y1l1�1 n by IC 6-1.1-12-.07).
of Aplic�nt ��� Address of Authorized Person