HomeMy WebLinkAboutMortgage_Greenwell (3)„,pas STATEMENT OF MORTGAGE OR CONTRACT
^�_:� INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
` VALUATION State Form 43709 (1-90) Prescribed by the
�`� Y��' 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
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.
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�AJUDITp� R 0-�s\O
Applicant (Qy��er or Co�act�uy�- se���st�rict o� ns on recxyQ{rse� ) /� I„, a^S yl
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Taxing.J�striit Key Number/Legal Descri3tiqr�5 ecor No. Q�
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U � Page No. �"�
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of Mar 1, current year as of March 1, current year. equitable owner? rJ yes O no_
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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:
o �-ass�
�'-^�e of mortgagee or contract seller��� ��Q (� • Q�_ 3(, 3 a
Wr�,�y.”` Q�.4sX'
A..ress of mortgagee or cqnirac eller �� ��� �� �
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Name of Assignee or other own holder f 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? �J yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�� � 19�` 19�-!(� 19 ( 19 60.Z 1' � D 1��0 �
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Signature Sec tary of B ard of Review Dat
eoy
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I/We certify under penalty of perjury thai the above and foregoing iniormation is true and corre t and that the appli-
�was/were a resident of Indiana and owner of the aforementioned property on March 1, 19 .
ture (owners full name) Person authorized by duly executed Power of Attorney or
� by IC 6-1.1-12-.07).
F�II Q��d�t Address of Aplicant Address of Authorized Person
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