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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
Filin fee $1.00
County Township Year
q3
File Mark
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. �QY 7 1993 �
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see re�ictions on r v�. se)
Key Number/Legal Description
�Iq- c�133b i
Assessed value of real property as Mortgage/Contract Indebte<
of March 1, current year as of March 1, current year.
�o�.r� . G�iu, ann.a,
If no, what is his/her exact share or interest?
Record No. (� 3
rage N .� p�n�
unpaid Is the plicant the sole I gal or
• equitapl wner? ❑ yes no
If owned with someone
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
Address of mortgagee or contract
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
1
, /
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Does appiicant 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 CJ 3- 9`i' 19 9� 1�_C�=O J 1
Signature Secret�ry of
7_�-S� ,e•o-6-�• �o�s-P
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.�y�
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rd of Review Datea oa S�
o� In o7 0� nq �
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
ature (owners full name) Person authorized by duly executed Power of Attorney or
_(�_ �� � ' -- �, by IC 6-1.1-12-.07).
II Resident dres�f Aplicant(� • Address of Authorized Person
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