HomeMy WebLinkAboutMortgage_Livermoren•� STATEMENT OF MORTGAGE OR CONTRACT fee $.1.00
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a�., INDEBTEDNESS FOR DEDUCTION FRdM ASSESSED Co y o Year
� ' VALUATION State Form 43709 (1-90) Prescribed by the
' State Board of Tax Commissioners .
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Instructions for filing: Wr�xR� ��� �
To be filed in person or by mail with the County Auditor of the county where the AUDITOK " Q
property is located during the 12 months before May 11 of the year the deduction Q
is to be effective. See reverse for additional instructions and qualifications. \
Applicant (Owner or contract buyer - see resiriction�,on re rse) -
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Taxing District Key Number/Legal Description Record No. a�
1'�'� m( q-V� J`[ S'�U Page No. �
V
Assessed value of real-property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole le
of March 1, current year as of Marc2h � currentyear. 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:
'! e of mortgagee or contract seller
Address of 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? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19� 19�� 19�� 1 OD 6 1�DrJ3 �
%! < . .01 � • �'Y '
Signature � o r�eS ry of Bo� � of �Review ��te
7-��9�' � �-6-�. • f' 9
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
� waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19
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Signature (owners full name) � Person authorized by duly executed Power of Attorney or
, by IC 6-1.1-12-.07).
Full R s ent Address of Aplicant Address of Authorized Person