HomeMy WebLinkAboutMortgage_Dawson (7)��°E STATEMENT OF MORTGAGE OR CONTRACT
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"a' a° : INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
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• ' VALUATION State Form 43709 (1-90) Prescribed by the
�• '' State Board of Tax Commissioners
� '
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.
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� Applicant (Owner or contr uy�{- see restrictiops�on rever�je`�
Taxing District
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Assessed value of real property as Mort�
of March 1, current year as of
fee $1.00
Township
MAY 1 � 7G00
Description I Record No. /�,� �
FORM 5
�
� - � �is0'Q Page No.
itract Indebtedness unpaid Is the applicant the sole legal or
. current year. equitable owner? O yes �7 no
5 Oc7 �i�nq4�
If no, what is his/her exact share or interest? I � If owhed with someone other than spouse,
indicate with whom.
If name on record is different than that of appticant, indicate below: • -
of mortgagee or contract seller
Address of mortgagee or contract seller
Name of Assignee or other owner or holder
AcJdress of Assignee
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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 J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year� b� Year
�.5 �'{��D� �
Signature
Year lY V I Year //[// I Year
Secretary of Board of Review
Year �p�__ Year ��
� P
Date
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
o�licants waslwere a resident of Indiana and owner of the aforementioned property on March 1,
tyre (owners full e)
7
esid t Address of Applicant
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Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Address of Authorized Person