HomeMy WebLinkAboutMortgage_Mayn•�E STATEMENT OF MORTGAGE OR CONTRACT
C`�' � O'4
��°y : INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
� '' VALUATION State Form 43709 (1-90) Prescribed by the
� d' State Board of Tax Commissioners
�
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
property is located during tiie 12 months before May i 1 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant (Owner or
�
-'see restrictions o
Key Numbe�/Legal Q�scription
Filin f�e $1.00
County Township Year
�
F�e f�9�k�
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NOV 0 3 1997 �
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�rd No. O S%
No. v 153�i
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 },�c�r�nt�l /a Oov-� equitable owner? O yes ❑ no
.
If no, what is his/her exact share or interest? I If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below: D� `J'f-- 2 3 S.
e of mortgagee or contract
Address of mortgagee or contract
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 Indiana7 requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 / � 19�ba 19_�% �
�19� Bel lgo'��
Signature
t s�_b_�2 �re�- 0,3
6, �,�.6 �
Secretary of Board f Review
aoo5 ���� aoQ�
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Date � rjc�
6-��-s� .. ,�
I/We certify under penalty of perjury that the above and foregoing ir�formation is true and correct and that the appli-
` was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�nature (owners full name) Person authorized by duly executed Power of Attorney or
� � r„ by IC 6-1.1-12-.07).
i� �t�Yidr�s oNqplicartt I Address of Authorized Person
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