HomeMy WebLinkAboutMortgage_Key���"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
x-' : FOR DEDUCTION FROM ASSESSED VALUATION
y � State Form 43709 (R / 12-99)
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� Prescdbed Dy State BoaN of Tax Commissioners
Instructions for filing:
To be filed in person or by maii with the County Auditor of the county where the property is
localed during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional instruclions and qualifications.
see 2strictions on �everse srde)
Taxing
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal description
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Mortgage / Contrad ii
March t�nt year
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debtedness unpaid as
FORM 5
APR 0 � 2001
GIB/�NTY AUDITOR
number � / _�
number
Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
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If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicanf, indicale below:
fame of moAgagee or contrad seller /� ,, n /� /
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Address of mortgagee or contrad seller (number and s et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state,
Does applicant own real property in any If yes, what county? Whai Taxing District? Has this deduction been requested on
other couniy in Indiana? property for current yeaft � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
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,•S �-13-01 �,-I�-na
Signature
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Secretary
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Date
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/ We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
�ture (o ers (ull name) Person authorized by duly executed Power of Attomey
�� , � , , or by IC 6-1.1-12-.07
authorized person