HomeMy WebLinkAboutMortgage_Loveless,.•��^o. STATEMENT OF MORTGAGE OR CONTRACT
�a�r�f} �� INDEBTEDNESS FOR DEDUCTION FROM �SSESSED
��;�� VALUATION State Form 43709 (1-90) Prescribed by ihe
-� �.�• State Board of Tax Comrnissioners
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Instructions for liling:
To be liled in person or by mail with Ihe County Auditor of Ihe counly where the
property is located during Ihe 72 monihs belore May 1 1 of Ihe year Ihe deduction
is lo be elleclive. See reverse lor addilional inslruclions and qualilications.
Filin tee $1.00
r Township Year
i
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MAR 17 1992
� AUDITOR � � �
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Ap licant (Owner or contract buyer - see resiriclions on reverse)
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Taxin istricl Key NumbedLegal Descriptio Record No. 7 Ct �
� � Do�r- oo �{60_�� "`�� Page No. �
l Fl9
Assessed value ol real properry as Mortgage/Conlracl Indebtedness unpaid Is the appticanl the sy legal or
ol March 1, currenl year as of March 1, current year. equitable owner? iB'yes
.�930 - � 9 �
If no, what is his/her exact share or interesl? If owned wiih someone olher than spouse,
indicate wiih whom.
If name on record is different Ihan thal o( applicant, indicate below:
Name of morigagee or contract seller � � �
Address of morigagee or coniracl seller
Name o( Assignee or other owner or holder ol Morlgage.
Address of Assignee
Does applicanl own real properly If yes, whal county? What Taxing Disirict? Has lhis deduclion been
in any other county in Indiana? requesled on properly for current
year? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduclion approved in Ilie amount ol:
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19 9tY 19�y'GOa 19 19� � 1� O d 3 19�
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Signature Secretary ol Board ot Review Dale o9
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I/We certify under penally of perjury Ihat lhe above and_foregoing information is true and correct and Ihat the appli-
c2�was/were a resident ol Indiana and owner ol ihe alorementioned property on Maroh 1, 19 .
Siy,�aWre (owners full name) p n � Person aulhorized by duly execuled Power of AUomey or
L iG� �vr�-C.ea�- by IC 6-1.1-12-.07).
Full Resi nt Address ot Apli anl Address of Aulhorized Person
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