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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 (Owner or
buy r -,see
�Key Nu
reverse)
�
I Description Record
�
No. �
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of M�ch 1, curre` year. equitable owner? � yes O 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 mortgagee or contract seller
Address c?f mortgagee or contract seller
of Assignee or other owner or holder of Mortgage.
Address of Assignee
9-/�G/
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? �7 yes �� no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature
19_�_p �_il, I ��29
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Secretary of Board of Review
19'_2�el� a-9_
— P1'ABa ik
Date
� / 8'�9
I/We certify under penalty of perjury thal the above and foregoing information is true and correct and that the appli-
�:s waslw re a resident of Indiana and owner of the aforementioned property on March 1, 19
S�(owners fu}i nam Person authorized by duly executed Power of Attorney or
� ,. �. � / by IC 6-1.1-12-.07).
Full Resident Asidress of Aplicant� ,// �j �� Addre,�s of Authorized Person