HomeMy WebLinkAboutMortgage_Cowling (2)�..,.p4 STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
a��=:{ `- INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
-`���.� VALUATION State Form 43709 (1-90) Prescribed by the
s• State Board of Tax Commissioners
File Mark
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the ����1
property is located duririg the 12 months before May 11 of the year the deduction �t��
is to be effective. See reverse for additional instructions and qualifications.
Applicant
Taxing
or
Key Number/Legal
JUN 14 1996
1pIT�R
�i Record No. 9s
'`(�V Paqe No. 7�r�s
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? 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 of applicant, indicate below:
of mortgagee or contract se
Address of mortgagee or contract seller
ame of Assignee or other owner or holder of Mortgage.
� qS_
Address of Assignee �� rn�
����%' 99-�3 s
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? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
. �; . ^' i
Signature
7��—��
1
' Secretary
� Oas
a- �� �
.://. ; •
i of Review
�� �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
- was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�gnatyre (owners f� name) „ Person authorized by duly executed Power of Attorney or
/ ,f l,m�, �!� .1/ ' � by ic s-i.�-i2-.o�>.
Full Resident Address of A�ilicant / I Address of Authorized Person