HomeMy WebLinkAboutMortgage_Pinnell"` �� , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
•_�- : FOR DEDUCTION FROM ASSESSED VALUATION
S � State Form a3709 (R / 72-99)
wa
_� Prescnhed by Slale Board ol Ta�c Commissioners
Instructions for filing:
To be filed in person or by mail with lhe Counry Auditor of the counly where the property is
localed during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side tor additional instructions and qualificalions.
FORM 5
MAY 0 7 20��
GIgSON COU�SY AU�
I Applicant (owne r contract buyer - see restpFtions on reverse side)
v�
Ta�cing Distrid Key number / legal description Record number
a�/�-07-�io.3�� l!� aa3
-� 0 I q- �31 I y- oU Page number Fy r� q
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Assessed vaiue of real property as of MoRgage / Contrad fndebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, current year �� O�� - owner? ❑ Yes ❑ No
S'
If no, what is his / her exact share of interest? if owned with someone other than spouse, indicate wiih whom.
If name on record is diHerent lhan that of applicant, indicate below:
�ame of moRgagee or contrect seller �
Address of mortgagee or contract seiler (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? VJhat Tauing District? Has this dedudion been requested on
oiher county in Indiana? property for current yeaR ❑ Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
zo � 20��3 zo zo zo o� 20 �h zo n y
S �,13.01 '� � `� � / �'
Signature �15i, O i Secretary of PTABOA Date
i r
I/ We certify under ihe penalty of perjury that the above and foregoing information is true and correcl and Ihat the applicants was / were
r idenl of Indiana and owner of the aforementioned property on March 1, 20
i S' nature (owners full name) Person authorized by duly executed Power of Attomey '
or by IC 6-1.1-12-.07
Full resident address of licant Address of authorized person
53� � �