HomeMy WebLinkAboutMortgage_Smith (44)n•n,t STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED - County Township Year
+' ,' VALUATION State Form 43709 (1-90) Prescribed by the
��... ` State Board of Tax Commissioners
Instructions for filing: ���;� l� ��5
To be filed in person or by mail with the County Auditor of the county where the , /
property is located during the 12 mbnths before May 11 of the year the deduction �� ,(�, �"�� v
is to be effective. See reverse for additional instructions and qualification�. AUDITOR .�tl�
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Applicant (Owner con act b er - ee r tric ions on rever )•
Taxir� District Key Number/Legal Description Record No. -
1 W' J "L`JGf k� Pa e No. ,� .
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Mar_ch 1, current year. � equitable owner? O yes ❑ no
a
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name.on record is different than that of applicant, indicate below: - ,
�' e of mortgagee or contract seller
: _ • � . " -
Address of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee • •
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? 0 yes ❑ no
COUHTY BOARD OF REVIEW AC710N ,
Deduction approved in the amount of:
19� 19�Q7 19 1 (��. f�OD�'_ 63 �� k9'�o �
� , �d f'
Signature aQ��cretary of�oarod�Review � �oG .P a0��'� �
7- a - 9� �C3- � � -
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
S ture (ow ers full name) — Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
ull Resident Address of Aplicant Address of Authorized Person
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