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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS. FOR DEDUCTION FROM ASSESSED
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 Courity Auditor of the county where the
property is located during the 12 months before May 11 of the year the deduction
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Filin fee $1.00
County Township Year
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8., �a99
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Applic (O ��L� ontract buy� - s�e/sJ{icti� on reverse) G18S�N �� tY pUO`j
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Taxing District Key Number/Legal Description Record No.
!ii//��i`��✓CTaN 009 —�J-U1�b'—O�'j Page No. � 7�
Assessed value of real 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
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:
Name of mortgagee or contract seller , �
/ 1' �' c' —t.'-�2 S � .
Address of mortgagee 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? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 19� a/L' t� a o 0 3 19 19_ `J 19
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Sign re _ Secretary of Board of Review Date
O �S �
I/W 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
C ture (owners full /fame)� Q Person authorized by duly executed Power of Attorney or
J�f1�c(.axe. L(J •/;L�;�(�G(�-��i by IC 6-1.1-12-.07).
ull Resident Address of Aplicant Address of Authorized Person
/ ll� o .� . �7666