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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
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 the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications.
Applicant
Assessed value of real p�operty as
of March 1, current year
as of
If no, what is his/her exact share or interest?
JUL 0 7 1999
� WU TY FUDITGR 1
Record No.
Page Na �
mtract Indebtedness unpaid Is the applicant the sole legal or
1, current year. equitable owner? ❑ yes � no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
of mortgagee or contract
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
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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? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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19a200 �S
Secretary of Board of Review � Date
19�i�
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
�nts 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
� � � � � N �. � �� by IC 6-1.1-12-.07).
Fuil R�dent Addr�ss of Apli ant
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Address of Authorized Person