HomeMy WebLinkAboutMortgage_Beard (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
\ � Str[e Fortn 43709 (R3 / 1 P90)
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� Presuibetl �y State Boartl of Taz Commissioners
Instructions for filing:
To be filed in person or by mail with the County AudRor of the county where the property is
located during the 12 months before May 11 of the year ihe dedudion is to be effedive. See
reverse side for additional instrudions and qualifications.
FORM 5
NOV 0 b 2001
GIB/�kTY AUDITOR
Applipnf (owner or confract buyer e restrictions on v e side) - .
Taxing Distri Key number / legal description Record number
.�.//-� ��— ��
,/� n'� Q/(�i �Q Q ^ O q� Page number
I W �� V
Asseued value of real property as of Mortgage / Contract indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, wrrent year March 1, curtent year owneR ❑ Yes ❑ No
� �5060 � �
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indiwte below:
N;�, of mortgagee or contrad seller � . .
� �, � �
Address of mortgagee or contract seller (number and street, cit , state,
ol- y97�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZlP code)
Does applipnt own real property in any If yes, what county? What Taxing DisUid? Has this dedudion been requested on
other counry in Indiana? property for arrent yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 j23_ 20 _-_ 20 a. i� 20 20 20 ��
s � � �, >° P p
Signature 8 9 County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and tnat the applicants was / were
��ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
ar by IC 6-1.1-12-.07
resident address of applipnt Address of author¢ed person