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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
NOV p 9 1998
Instructions for filing: '
To be filed in person or by mail with the County Auditor of the county where the GiesoN
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See reverse for additional instructions and qualifications.
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Applicant ( ner or contr ct buyer - re trictions on re erse) .
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Taxin Di$trict Key Number/Legal Description R cord No. �Q $`
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Q� g- Page No. � 5� 3
Assessed value of real property as Mortgage/Contract Inclebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
P��me of mortgagee or contract seller
ddress c?f mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19�Qd 19 ( 19� �IiO� 19 j$_�.S'"
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Signature ecretary of Board of Review Date
ab o� o ��r/� �
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�'s was/were a residen f Indiana and owner of the aforementioned property on March 1, 19
n re (owners full napie) Person authorized by duly executed Power of Attorney or
� by IC 6-1.1-12-.07).
Full Residen /d��dress of Aplicant Address of Authorized Person
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