HomeMy WebLinkAboutMortgage_Dick<•�•�„ STATEMENT OF MORTGAGE OR CONTRACT
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,�°e; INDEBTEDNESS FOR DED'JCTI/JN FROM ASSESSED
'� ' VALUATION State Form 43709 (1-90) Prescribed by the
� State Board of Tax Commissioners
Instruction or filin :
To be filed in son by mail with the County Auditor of the county where the
property is locat d ng the onths before May 1� duction
is to be effective. r ad- � io I i str ti n n li c�t�ms.
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Applicant (Owner
Tax
Filin fee $1.00
Cou ty Township Year
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�J
o�o�`�e���
�� ��� � 3 1995
Key Number/Legal Description � Record No.
–�C J 0�� S�– � � � Page No.
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Assessed va�ue of real property as Mortgage/Contract Indebtedness unpaid Is the applicant tlie sole�legal or
of March 1, current year as of Maycl�}�,.�urrsqt yea� equitable owner? O yes O no
If no, what is his/her exact share or interest? If owned with someone other than spouse,
\ indicate with whom.
If namp� nc[�{e _ iffeFent than that of applicant, indicate below:
Address of mortgagee
Name of Assigne or i
Address of Assignee
seller
contract seller
owner
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Does applicant own !eal property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
i s�91.
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Signature `� Se��tary of�� arOd,pf ��view Date �D6 4/ a oO,i
� - � - 5 �' �3. �-.� • e Pf P r�
. certify under penalty of perjury that the above an 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
y a(ure (owners full,Rar�el � Person authorized by duly executed Power of Attorney or
' � . ,�/ f��i_ � by IC 6-1.1-12-.07).
���dent A ress of A lica Address of Authorized Person
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