HomeMy WebLinkAboutMortgage_Dick (5)� R�q
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R / 12-99)
Presaibed by State BoarE of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the Counry Auditor of the counly where the property is
located during the 12 months before May 11 of the year the dedudion is to be effective. See
reverse side for additional instructions and qual�cations.
Applicant (owner or contract buyer - see restrictions on verse side)
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Taxing Districl rKey number / legal descnptwn
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Assessed vatue of real property as of MoRgage / Contract ii
March 1, wrrent year March 1, current year
If no, what is his / her exacl share of interest?
If name on record is different than thal of applicant, indicate below:
FORM 5
Filing fee 31.00
Coun Township Year
F I L���kI�
APR 2 3 2001
G�OUNTY AUD
Record number
4�
�age number
�
�s unpaid as of
Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, iridicate with whom.
of mortgagee or contract sel�er
of mortoaae� or contract
and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
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Does applicant own real property in any If yes, what wunty? What Tauing District? Has this deducfion been requested on
other county in Indiana? property for current yeaf� ❑ Yes 0 No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
20 �� QQ
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20 � � 20
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Seaetary of PTABOA
20 nTr� � 20
Date
20 �
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� � I/ We certify under the penalty of perjury thal the above and foregoing information is true and corred and lhat the applicants was / were
� resident of Indiana and owner of lhe aforementioned property on March 1, 20
full name)
address of
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Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of auihorized person