HomeMy WebLinkAboutMortgage_Pugh (3)�" i STATEMENT OF MORTGAGE OR CONTRACT tNDE
-- ; FOR DEDUCTION FROM ASSESSED VALUATION
'� �+ State Form 43709 (R / 12-99)
Prescribed by State Board of Tax Commissioners
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InsVuctions 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 the year the deduction is to be effective. See
reverse side for additional instructions and qualifications.
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51.00
File Mark
ti01�N(10� NOS81J
lUOZ 8 0 Nd f
Applicant (o n or contract 6uy r- ee restricfio� on reverse side)
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Taxing District Key number / legal description Record number Q/
P�T � (J (�+1" � Q'L.J � Q��� 0� .�Z /�OQ Pagenumber � /
Assessed value of real property as of Mortgage / Contrad ihdebtedness unpaid as of Is the applicant the sol legal or equitable
March 1, curtent year March 1, current year � ownef.� ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�ame of mortgagee or contract seller
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Address of mortgagee or contracl seller (number and sheet, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does app�icant own real property in any If yes, what counry? What Taxing District? Has this deduclion been requested on
other county in Indiana? property for current yeaf� � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
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20 �� 20 �� O� ]� �6 20 O 20 20 20 ��
. .e1 - �,•by �� P-r�oor�- �
Signature Seaetary of PTABOA Date
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I/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that Ihe applicants was / were
resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
' nature n full e) Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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