HomeMy WebLinkAboutMortgage_Mitchell (6).^•�•4 STATEMENT OF MORTGAGE .OR CONTRACT
� A e
?,�_ y. INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
•�� VALUATION State Form 43709 (1-90) Prescribed by the
� State Board of Tax Commissioners
Instructions for filing:
FORM 5
Filin fee $1.00
County Township Year
;.,.,. ,��� OC�
',
a
C�'j Q �Fi#��ark
To be fded in person or by mail wdh the County Audrtor of the coun y where the '
property is located during the 12 months before May 11 of the year the deduction �
is to be effective. See reverse for additional instructions and qualifications. �: ;"�""�''��
n �� . 1'3UN �`�Ut Y nUCITOR
Applicant
Taxing District
or contrac� buyer -
0�9 -ocgal-o�o
Key
No.
No. 3 S'
Assessed value ot real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1,� rr�tyear. equitable owner? O yes rJ no
�
If no: what is his/her exect 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: , -
mortgagee or contract seller
s of mortgagee or contract seller
Name of Assignee or other owner or
Address
of Mortgage.
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 ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year � Year �� Year _�� Year� a.Q� Ye DO Year �� Year �
�1 s` as �► , _o P
Signature Secretary of Board of Review Date
a�af aoo .�oo
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the
,�licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
Resident
full
of
CJ
Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Address of Authorized Person