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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county �rhere th
property is located during the 12 months before May 11 of the year the deduction
ic tn ho offortiva Soa rovarcc fnr ari(iitinnal incfrnrtinnc an�i niialificatinnc
Filin fee $1.00
County Township Year
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NOV 10 1991
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Appiicant wner or con act buye��� e restriciions on reverse) �;BSON rn`����Y •�+.� '• '
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Taxing District Key Number/Legal Description Record No. C�G�
7
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
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If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
�-ne of mortgagee or contract seller
Address of mortgagee or contract sel � �/ �
Name of Assignee or other owner or holder of Mortgage. ,
Address of Assignee
Does applicant own real property If yes, what county7 What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19� 19�0� 19�� 1�1 1��_b!� 1��� �$oGt�
6 c��� � . O
Signature Secretary of Board of Review Date
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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-
's was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
Siqnature (owners full name) Person authorized by duly executed Power of Attorney or
Q� by IC 6-1.1-12-.07).
Full Resident Addr ss of Aplicant Address of Authorized Person
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