HomeMy WebLinkAboutMortgage_Dehosse�T°•a STATEMENT OF MORTGAGE OR CONTRACT
�;'`.. .
a�°,� °, INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribe� by the
�.�• '� State Board of Tax Commissioners
Instructions 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 for additional instructions and qualifications.
Applicant
Taxing District
,
or coryi�act buyer -
on reverse)
r
Fil
- r 1\ ���e �
�° � t, ..�.
�R 2� ti���
, FORM 5
1.00
O`i �' U�b 1�} ^ UO Page No.
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 �J 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:
or contract sell
" ' —
mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
x
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana7 requested on property for current
year? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
�,/�Year Yea�C�11� ���+� YBdr8D3 Ye�6� Year�� Year
1'� � S-bl - - o�, $iJ
Signature � 7�FS � 4 Secretary of Board of Review Date
P � ,�
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
�licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
iignat �re1 (owners f IIq1a\me) I Person authorized by duty executed Power of Attorney or
� �L... I� I\In � h� � � by IC 6-1.1-12-.07).
ress of Applicant � Address of Authorized Person