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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State.Form 43709 (1-90) P_rescribed by the�
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
orooertv is located durinq the 12 months before May 11 of the year the deductiorr� E C
14 1999
is to be effective. See reverse for additional instructions and qualifications �' / n
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Appli n o t buy r, se estriciions on reverse)
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T i � rict Key Number/Legal Description Record No. � _ b*i �
� O ��'- �� ��V� Page No
Assessed value of real property as Mortgage/���Coiis"""ntract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of Mar� �r e��� equitable owner? O yes � no
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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:
ame 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? ❑yes rJ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19� 19��J� �03 1�'� ��o • 1�"o'ZOaS 19�(2
a
Signature q__ Secretary of Board of Review Date
� o o y-�O aoo�- �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appii-
�nts waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19
. ature (ow� me Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident Address o( Aplicant Address of Authorized Person