HomeMy WebLinkAboutMortgage_McDaniel (2),,Ei=•TMa STATEMENT OF MORTGAGE O CONTRACT
af�°y `; INDEBTEDNESS FOR DEDUCTION FROM D
���,' VALUATION State Form 43709 (1-90) Pres�ri el�6y�t,he,,,
'�' State Board of Tax Commissioners / ��,(/
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Instructions for filing:
To be filed in person or by mail with the County
property is located during the 12 months before
is fo be effective. See reverse for additional ins
Applicant
Key
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itor atshe-Eounty where the
11 of the year the deduction
isns and aualifications. r .
reverse)
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Filina fee $1.00
ear
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Record No.
No.
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Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legakdr`;
of March 1, current year as of M 1, current ear. equitable owner? O yes O no
If no, what is his/her exact share or interest? If owned with someone other than spous ,a
indicate with whom. 6 y
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
of mortgagee or
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
i year? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19��/'� I1
iG'iS���il
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Signature Secreta�' of ard of Review Date aoo �-� � c�
- %--2—cl� �,o-�, �'b o,�6C�� ��d� � � �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and t at the appli-
's was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
:.. iature (owners full name) Person authorized by duly executed Power of Attorney or
� ' . _„ „ �_ ' ,) by IC 6-1.1-12-.07). /
Address of Aplicant � Address of Authorized Person