HomeMy WebLinkAboutMortgage_Hollingsworth.�"•'<. STATEMENT OF MORTGAGE OR CONTRACT
:�� INDEBTEDNESS FOR DEDUCTION FRdM 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
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is to be effective. See reverse for additional instructions and qualifications� %,� � �%� �
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Applicant (Owner or contract buyer - see res rictions on reverse "
Taxing District y N m er/Legal D scription No. OO
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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? rJ 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 mortgagee or contract seller
Address of mortgagee 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? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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Signature 9 _ Secretary of Board 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-
its was/were a resident of Indiana and owner of the aforementioned property on March t, 19
-aignature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
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Full Resident Addres f Aplicant Address oi Authorized Person
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