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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Form 43709 (R / 12-99)
Prescnbed by State Board oi Taz Commissioners
FORM 5
Filing fee 51.00
Coun Township Year
File Mark
InsVuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is �����
located during fhe 12 months before May 11 of the year the dedudion is to be effective. See
reverse side for additional instructions and quaiifications.
buyer
Taxing Districl
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Assessed value of real property as of
March 1, current year
restrictions on
If no, what is his / her exact share of interest?
Key number / legal description
Page
MAY 2 20U1
Mortgage / Contract indebtedness unpaid as of I Is the applicant the sole legal or equitable
March 1, current year owne(? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
name on record is different than thal of applicanf,
of mortgagee or contract
below:
of mortgagee or contract seller (numbe� and stieet, citY, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own real property in any If yes, what wunty? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaf? 0 Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in lhe amounl
20 �J y
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Secretary of PTABOA
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Date
/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
�esident of Indiana and owner of the aforemenlioned property on March t, 20
(owners
Person authorized by
or by IC 6-1.1-12-.07
person
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