HomeMy WebLinkAboutMortgage_Sullivan� rt�A � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'— . i= FOR DEDUCTION FROM ASSESSED VALUATION Counb
�, � Sfate Fam 43709 (R / 12-99)
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Prescribed by Slate Board ot Tac Commissioners /
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Instructions for filing:
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 t t of the year the deduction is to be effective. See
reverse side for additional instructions and qualifications.
Applicant (owQefor c n ct bu er- see
Tax�istrict
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Assessed va ue of reai property as of
March 1, current year
If no, what is his / her exact share of interest?
nons o rever
FORM 5
Filing fee 51.00
r Township Year
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File k
FEB 13 2001
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Key number / leg description Record number O�
/\ I Q' , o 178 3_ o o Page number ��
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Morlgage / Contract ihdebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
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if owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�ame of mortgagee or contract seller ^ „ �
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Address of mortgagee or contrad seller (num er and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has lhis deduction been requested on
other wunty in Indiana? propeRy for current yeaf? � Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduclion approved in the amount of:
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20 (/ -� I 20
Seuetary of PTABOA
20 0 S
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20 �'
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Date
20 �
/ We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
g ture (owners /ull name Person authorized by duly executed Power of Attomey
� � �� �.' � � _ (� 0 . � _ _ or by IC 6-1.1-12-.07
II resident addres f appficant Address of authorized person
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