HomeMy WebLinkAboutMortgage_Embree„E��°Ea STATEMENT OF MORTGAGE OR CONTRACT
a�,r`°-� ° INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the Cou
e ���• '. State Board of Tax Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
Townsh
(�9Af� 13 199�
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property is located during the 12 months before May 11 of the year the deduction n
is to be effective. See reverse for additional instructions and qualitications. �GP�y�yuv,Fy, ry s
,� AUDITOR�
Year
Ap icant wner o contract b r- see restrictions on reverse)
T istrict Key Number/Le al Description Record No. �
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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 Mar 1, current year. equitable owner? O yes ❑ no
- 53
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 mortgagee or contract seller , .� ��,�� �
� � .��A. �/�'+�-'ruu”
Address of mortgagee or contract seller
Name of Assignee or other owner or hotder 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 O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19_p5- �j�i 19 19 - a� 19�4 � 1 1�� 1��,3
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Signature Sec etary of Board of Review , Date��6 _
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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
L , by IC 6-1.1-12-.07).
Ful Resident Address of Apiicant Address of Authorized Person .
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