HomeMy WebLinkAboutMortgage_Roberts� rt"� ; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-�:. ': FOR DEDUCTION FROM ASSESSED VALUATION
•� , Stale Form 43709 (R / 12-99J
�� Prescri0ed by State Board of Ta�c Commissioners
Instructions for filing:
To be filed in person or by maii with the County Auditor of the county where the property is
localed during the 12 months before May 11 of the year the dedudion is to be effeciive. See
reverse side for additional instructions and qualifications. \ I
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Assessed value of real property as of
March 1, curtent year
no, what is his / her exact share of interesf?
on r�yers� side)
Key number / legal description
FORM 5
Filing fee 51.00
Coun Township Year
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FEB 6 2001
G�gSON COUNTY AUO
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Mortgage / Contract indebiedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year ownef? ❑ Yes ❑ No
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�f owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate
'ame of mortgagee or contract seller / ` I
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Address of mortgagee or contrad seller (number and stieef, city, state, :
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, cify, state, ZIP code)
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Does applicant own real property in any If yes, what county? What Taxing Dislrict7 Has this dedudion been requested on
other county in Indiana? property for current yea(? � Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
20 ��–
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H" u-V-�1a� \` I Z� � I 20 �—
Seaetary of PTABOA
20 �,r � 20
20
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/ We certify under the penalty of perjury lhat the above and toregoing information is true and corred and lhat the applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
gnat re (owne�rns fu/�p name) Person authorized by duly executed Power of Attomey
� Y 1"14Ai ��� _ or by IC 6-1.1-12-.07
ill're�id�it address of applicant ' Address of authorized person
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