HomeMy WebLinkAboutMortgage_Decker (3)���° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEce
-- : FOR DEDUCTION FROM ASSESSED VALUATION
; p' S�ate Porm 43709 (R / 72-99j
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Prescri�ed by State BoaN ot Ta+c Commissioners
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FORM 5
InsUuctions for filing:
To be filed in person or by mail with the County Auditor of fhe county where the property is qpR 18 2001
located during the 12 months before May 11 of the year the deduclion is to be effeclive. See
reverse side for additional instructions and qualifications. � ��j
(owner or confract buyer- see restrictions c� reverse
Distrid
e�
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
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Key number / legal description Record number ��
Page number , 1 1 � �
o� � � �-�o -t \
Mortgage / Contract ihdebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year - ownef? ❑ Yes ❑ No
�a� ��
If o ned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicanf, indicate below:
mortgagee or contract
. ,. .
of mort�agee or contract seller (number and st2et, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has fhis dedudion been requested on
other county in Indiana? property for current yeaR � Yes ❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Dedudion approved in the amount of:
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�ignature � 9 Secretary of PTABOA Date
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I/ We certify under the penalty of perjury Ihal lhe above and toregoing infortnation is true and correct and that the applicanls was / were
'resident of Indiana and owner of the aforementioned property on March 1, 20
iignatur (o s lull nam ) Person aulhorized by duly executed Power of Attomey
�O - G ' \ �% _, , _ or by IC 6-1.1-12-.07
of applitxnt �) �Address of authorized person