HomeMy WebLinkAboutMortgage_WelchrE��°F4 STATEMENT OF MORTGAGE O TRAC �-F• • p
�i�°:� '; INDEBTEDNESS FOR DEDUCTION FRG County sh4 , `fi�ar
•e���� VALUATION State Form 43709 (1-90) Prescribed by the ��;_.t.,, ,
�� 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.
File Mark
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AUDITOR'��
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Applicant (Owner or contr buyer - see res ctions on reverse)
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Taxin District Key umber/Legal Description ecord o. �/
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- N� ia-3- � a' 3c°� Pa ge No. � ai �.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the'''��` s��/ole legal or
of March 1, current year as of March 1, current year. equitable owner? �yyes ❑ no
900 - ��3d l g oo� . ,-
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If ine on record is differ t than that of applic nt, indicate belo :
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'��ne of mortgagee or contract seller �p
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Address of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own !eal 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��g S 19� 19� O 19 19Q1 fj_Q�2 �Q�Oy k9"�
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Signature Secre1a-ry of ard of Review Date appf/
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6-i9- 9S� B•��• (Qll� , oy-
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that th appli-
� � waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19
� �ature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
II Resid nt A dress of Aplicant Address of Authorized Person
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