HomeMy WebLinkAboutMortgage_Pickett� �,.,�
4
� �
.��
, ,•;�`1
�
STATEMENT OF MORTGAGE OR CONTRACT
INOEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
. - ��
� o �e �
� � s � zE` ��
,
, ���
Instructions for filing: n
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 the year the deduction K N,
is to be effective. See reverse for additional instructions and qualifications. 3 Gissors c�c�UtdTY hUDITO�b
_ � _ CJ� ��%
Applican wner or cont�ct�b er - se estrict s on rever e)
Taxi�istrict Key Number/Legal Description Record No.
/`�
� \ Page No. ,S3s
Assessed value of reai property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal o
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 o applicant, indicate below:
. �
Name of mortgagee or contract seller
Address of mortgagee or contract seller T_ n__ /1,,
1 SL.Y-�1�.. 1 0�
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? �7 yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�JC�J � 19� 19 OOA �Bt1�� �3-_� 1S �o0 19TJ �
5 6-19�1 �-a6 - n � �"AOo� l°
Signature _ Secretary of Board of Review Date
m'1 � � ���olrt 9
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts waslwere a.resident of Indiana and owner of the aforementioned property on March 1, 19
- n owners full namel Person authorized by duly executed Power of Attorney or
• � by IC 6-1.1-12-.07).
� II Resideni Address of Aplicant Address of Authorized Person
�Py2 �'/ /�o X o D