HomeMy WebLinkAboutMortgage_Majewski.•T•�•a STATEMENT OF MORTGAGE OR CONTRACT
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a' INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
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" ' VALUATIO� State Form 43709 (1-90) Prescribed by the
/� d'� State Board of Tax Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
orooertv is located durina the 12 morths before Mav 11 of the vear the deduction
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is to be effective. See reverse for additional instructions and qualifications. (�
�� i c��cr;d COIihTY hU�
Applic nt contract b er - ee restrictions on reve e)
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Taxing District Key N er/Legal Description Record No.
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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 ❑ no
ODO -
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:
12.L
�me 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 !eal 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��pa 19 19 DO} �� �OO>-os 19� �daS�
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Signature ,�� . Secreta of Board of Review Date
a66��606 o2D0%—� a� o`� �l�Lq9
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
,ts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�.�natur (owners full name) . Person authorized by duly executed Power of Attorney or
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� by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person