HomeMy WebLinkAboutMortgage_HaugerCS�p44 STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
a�sy `; INDEBTEDNESS FOR DEDUCTION FROM ASSESSED County Township Year
'� ' VALUATION State Form 43709 (1-90) Prescribed by the
.� •'� State Board of Tax Commissioners �'
�
� File Mark
Instructions for fiiing: �����
To be filed in person or by mail with the County Auditor of the county where the �
property is located during the 12 months before May 11 of the year the deduction . .
is to be effective. See reverse for additional instructions and qualifications. \
F E 8 1! 1991
Applicant (Owner or ontr t buyer - see restrictions on reverse) ��-s
AUDITOR
Taxi trict K N�mb�`/ gal$e�c iption Record No. �
/ (� ,��
,�t�u.�6".' � dJ�,.��o�-"��o'l Page No. '(3
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, curre�t year. equitable owner.'�rJ-yes�0 no
aao� - q��o �. �
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:
N2me of mortgagee or contract selle
,r �.
Address of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address oi 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 19� 19� O 19� � 19���.1. � 0 j� aa3
G-a.f-o/ - - a2
Signature Sec tary of Board of Review Date �
6 0 0� a�b0
7-8-9P ,Q,�-�• zcos'-/`' � � f o9
I/We certify under penalty of perjury that the above and foregoing information is true and co rect and that the appli-
r'� was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
,, ur owners full name) � Person authorized by duly executed Power of Attorney or
x by IC 6-1.1-12-.07). �
Full Resident Address of A licant /� �f 70 Address of Authorized Person �
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