HomeMy WebLinkAboutMortgage_Reneer��� : STATEMENT OF MORTGAGE OR CONTRACT�INDEBTEDT
'- : FOR DEDUCTION FROM ASSESSED VALUATION
S � State Form 43709 (R / 72-99) ' '
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PrescnbeC by State Board of Tax Commissioners
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InsVuctions for filing:
To be filed in person or by mail with the Counry Auditor of the county where the property is
localed during the 12 months before May 11 of the year lhe dedudion is to be effedive. See
reverse side for additional instructions and qualifications.
Appiicant
Taxing
� VC/ �
Assessed value of real property as of
March 1, current year
no, what is his / her exact share
on reverse side)
� - -���:FORM
Fdmg fee $1 00
JAN 0 9 2001
Key number / legal descnption Record number ��
�ln/iy'� �T Page number �
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Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year i owneR ❑ Yes ❑ No
If owned with sy�neone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
/me of mortgagee or contract seller '� �', I
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Address of mortgagee or contrad seller (number a d st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaR � Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in lhe amounl of:
20�� 20 20
�� /' 13' D� ,C��t,�1,� i �
20
Signature C�$ 09 � Secretary of PTABOA
tl' /
20U5
�
20
Date
20 ��1
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person
r,'ncefon �C