HomeMy WebLinkAboutMortgage_Dishon;.�°�4 STATEMENT OF' MORTGAGE OR CONTRACT
a' a.`; INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
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" ' VALUATION State Form 43709 (1-90) Prescribed by the
•'� State Board of Tax Commissioners
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In�ctions 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.
S
�AUD TOR
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Applicant (Owner or c ntract buyer - see restrictions on reverse)
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Taxing District Key NumbedLe Description Record No. C��a
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8'1l�,Q,�—h'Ovtk. 2Z Page No. ��$�%
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant th���e rrrsole legal or
of March 1, current year as of March 1, current year.. equitable owner? 1�p yes O no
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If no, what is his/her exact share or interest? If owned with someone other than spouse,
i�dicate with whom.
If name on record is different than that of applicant, indicate below:
fy��e of mo gagee or contract geller
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�ss of mortgagee ontract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19� 19�� 19 19� �fZQ� 1'�1 B03 �$ DQ S�
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Signature � a60s retary�� � oard �O�evOi�w �ate
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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
; nature (owners full name) Person authorized by duly executed Power of Attorney or
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� � by IC 6-1.1-12-.07).
Resident Address f Aplicant Address of Authorized Person
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