HomeMy WebLinkAboutMortgage_Riley (3)� rt�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f-' ._ r FOR DEDUCTION FROM ASSESSED VALUATION
S � State Form a3709 (R / 12-99J
�a.
y� Prescribed by State Board of Tax Commissioners
FORM 5
Insvuctions for filing: pPR � 2 2�01
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 dedudion is to be effeclive. See/ I������
reverse side for additional instructions and qualificalions. �
� GIBSON COUN?'/ P.UDI i0,°.
- se�nestncuons on reverse
Taxing Distrid Key number / legal description r I � I Record number �/_ •
n U
�p�✓/� -� � _b� Page number , _
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Assessed vatue of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the soie i�y�. .,.•equitable
March 1, current year March 1, current year � owne(? ❑ Yes ❑ No
�/ ���
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
I( name on record is different than that of applicant, indicate below:
�ame o( mortgagee or contract seller ,^�
� .�� f
Address of mortgagee or contracl seller (number and st t, city, state, ZIP
Name of assignee or other owner or
Address of assignee (number and st2et,
of mortgage
state,
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 the amount of:
20
Signature
20 � � 20 �_
c
20 ��
Secretary of PTABOA
20 � I 20
Date
20 ��/�_ 0 R
7-' %
We cerlify under the penalty of perjury that the above and foregoing in(ormation is true and correIX and that lhe applicants was! were
esident of Indiana and owner of the aforementioned property on March 1, 20
n�re (o�s lull n�vne) )� 1 ,; Per� n authorized by duly executed Power of Attomey
�i� l �� or b IC 6-1.1-12-.07
Full resident address of applicant � ' (/ IAddress of authorized person