HomeMy WebLinkAboutMortgage_Wolf,��'•'E� STATEMENT OF MORTGAGE
e ` INDEBTEDNESS FOR DEDUCTION
�� VALUATION State Form 43709 (1-90
�`' State Board of Tax Commissioners
�
Instructions for filing:
OR CONTRACT
FROM ASSESSED
) Prescribed by the
To be filed in person or by mail with the County Auditor of the county where the �UN 16 1999
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. /�� J��
� GIBSON �. Ut1T't AUDITOR
Applicant (Owner or contract bu r- see restr ciions on reversel .
�..J �--
Taxing District - Key Number/Legal Description Record No.
O � - Page No. Q �
Assessed value of reai property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes � no
g �O
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 oi applicant, indicate below:
Name of mortgagee o� contract seller
Address of m gagee or contract seller
Name of Assignee or other owner or holder of Mortgage. '
Address of Assignee
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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature _ Secretary of oard of Review Date
�DO �-� � ° I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
nts was/were 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).
Full Resident Address of Aplicant Address of Authorized Person
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