HomeMy WebLinkAboutMortgage_Smith (3),�ES'"'E � STATEMENT OF MORTGAGE OR CONTRACT
e � INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
,� VALUATION State. Form 43709 (1-90) Prescribed by the
�`' State Board of Tax Commissioners
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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 moriths before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Filin fee $1.00
County Township Year
File'iVl� i
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p,pR 18 2000
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App�icant (Owner or contrac buyer - see restrictions on �everse) � �; ,.,?4�,; �.'jUnTY ��U0170n
Taxing District Key Number al Description � Record No. Q
� � `�� aa-O PageNo. a-3
Assessed value of real operty 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:
me of mortga e or contract seller
�Address of e 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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�ii1- �p�,B L�J ai0o 3 19 � 19 � 19 19�
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Signature 9 _ Secretary of Boa d of Review Date
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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 .
�ignature ( wners full name) Person authorized by duly executed Power of Attorney or
� by IC 6-1.1-12-.07).
Fu Resident Address of Aplican Address of Authorized Person
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