HomeMy WebLinkAboutMortgage_Haas (3)=St��F4 STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
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��--_ �; `; INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
�`, � VALUATION State Form 43709 (1-90) Prescribed by the
�, •` 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 ;he year the deduction .
is to be effective. See reverse for additional instructions and qualifications. �� O � j998 �.
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Applicant (Owner or ont act buy - see res icti s on rev e) G����,, �,,,,;,iv'`� T/1p
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T' District y Number/Legal Desc tion Record No. /,?,
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March t, current year as of March 1, current year. equitable owner? ❑ yes ❑ 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:
��e of mortgagee or contract seller � ,�
Address c?f mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount oi:
19 � 1�� 19 � 19�(�' �bb� 1�1jD',� 1�60�
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Signature Secretary of Board of Review Date -
aDO.s- ° oi o 09 �-ii -S�'.
I/We certify under penalty of perjury that t e above and foregoing information is true and correct and that the appli-
s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
;gnaScf�r (owners full na e . Person auth"orized by duly executed Power of Attorney or
•10 by IC 6-1.1-12-.07).
ull Resident Address of Aplicant Address of Authorized Person
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