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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 County Auditor of the county where the
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant (Ow(�r,or contract buye�see restrictiorjs'qn reverse)
District Key Number/„Ykgal Description
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Filin fee $1.00
County Township Year
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File Mark
SEP 2 3 1999
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GIBSOt? C=�ii`.�Tl' :aUD170Fi
Record No.
No.
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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? I 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 seiler
of mortgagee or contract seller
Assignee or other owner or holder of Mortgage.
Address of Assignee
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Does appiicant 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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Secretary of Board of Review � Date
1
certify under penalty of perjury thai the above and foregoing information is true and correct and that the appii-
; was/were a resident of Indiana and owner of the aforementioned property on March t, 19
3ture wn rs full name) Person authorized by duly executed Power of Attorney or
� � by IC 6-1.1-12-.07).
3esident Address of cant Address ot Authorized Person