HomeMy WebLinkAboutMortgage_Prinzing��'��` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
x-' .: FOR DEDUCTION FROM ASSESSED VALUATION
`� � State Form 43709 (R / 12-99)
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Presaibed by State Board olTax Commissioners
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InsVuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during lhe 12 months before May 11 of the year the deduction is to be effective. See
reverse side tor addilional instruclions and qualifications.
Applicant (byr�gr or cont2ct buyer - see
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Taxing Dislrid
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Assessed value of real property as of
March 1, current year
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Key number / legal description
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Mortgage / Contract indeb
March 1, current year
FORM 5
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Recard
I Page number
d'—a�
iess unpaid as of Is the ap�
,owner?
MAR 0'i 2UU1
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�o�s
the sole legal or equitable
❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanf, indicate
�ame of moRgagee or contrad seller
1 G� ��s �r�e 4 0 .
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 (num6erand street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? Whai Taxing Distrid? Has this deduction been requested on
other county in Indiana? property for current yea(�� YesO No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
approved in the amount of:
r� � ��, <:
•/3- 6
Signature
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Secretary of PTABOA
20�'� 20,
4 �
Date
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/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
gnature (owners (ull na�ej� Person authorized by duly executed Power of Attomey
/V� � I I� � n,_� or by IC 6-1.1-12-.07
address of applicant V U� Address of authorized person
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