HomeMy WebLinkAboutMortgage_DemossR•�v STATEMENT OF MORTGAGE OR CONTRACT
�; INDEBTEDNESS FOR DEDUCTION-FROM ASSESSED
_- ?' VALUATION State Form 43709'(1-90) Prescribed 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
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� �AUDITOR�s
Appli�nt (Ownefo� contra stricti s on reverse)
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Taxi istrict Key Number/Le al Description Record No.
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�, � Pa e No. d
Assessed value of real property as Mortgage/Co ract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes 0 no
0 � 0- 15 000 � Dd�
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:
'-�e of mo e or contract seller
Address of mortgagee or contract seller _
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee • - , . . .
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 ❑ no
COUNTY BOARD OF REVIEW ACTiON
Deduction approved in the amount of:
19� 19�OJ 19 19�2 f�pb'� bQf>63 1�Ddf
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Signature Secretary of Board eview Date
aooS' �o a �7 � oR
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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
Signature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
ull Resident Address of plicant Address of Authorized Person