HomeMy WebLinkAboutMortgage_Coomer� rt�A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-- _: FOR DEDUCTION FROM ASSESSED VALUATION
•> > State Form 43709 (R / 12-99)
Prescnbed Oy State BoaN of Tax Commissioners
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InsVuctions for filing:
To be filed in person or by mail with the County Auditor of the counly where the property is
localed during the 12 months before May 11 of the year the deduction is to be effective. See
reverse side for additional instructions and qualifications.
FORM 5
MAR � O Z001
GIB�NTY AUDITOR
4pplican o ner or conttac 6uyer- see rest ' tions on rev rse slu -
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Taxing Distrid Key number / legal description Record number f� /�
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� /wJ�� / /�_ bo t �73 ,�� Page number /� I / �
\� i e j�:— � 7
Assessed vatue of real properfy as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or e
March 1, current year March 1, current year owneR ❑ Yes ❑ No
�5 aa o
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate belo�
Name of mortgagee or conlrad seller
1 �/1!
Address of moRgagee or contraci seller (number and street, city,
D�-
Name of assignee or other owner or holder of moAgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Tauing District? Has this dedudion been requested on
other county in Indiana? property for current yeaR ❑ Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
approved in the amounl of:
zo �,_ Qpp.p�(-/8- zo � zo � 20 �_ zo �� zo �
6-�3-a rt� � f A � �
Signature /19, ��% Secretary of PTABOA Date
/ We certify under the penalty of perjury that the above and foregoing information is true and wrred and that the applicants was / were
resident o( Indiana and owner ot the aforementioned property on March 1, 20
�nature (owners /ull name) Person authorized by duly executed Power of Attorney
� '� � . _ � � � ., n _. O� by IC 6-1.1-12-.07
address
O•
of auihorized person