HomeMy WebLinkAboutMortgage_Tate,�T°•a STATEMENT OF MORTGAGE OR CONTRACT
�TP ` INDEBTEDNESS FOR DEDUCTION FROM-ASSESSED
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' VALUATION State Form 43709 (1-90) Prescribed by the
�� State Board of Tax Commissioners
�
Instructions for filing:
To lie 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 deduction
is to be effective. See reverse for additional instructions and qualifications. /
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Applicant (Ov�r or co
on reverse)
FORM 5
fee $1.00
Township Year
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Taxin District � ` Key NumbeNLegal Description Record No. b[-.+
� � g,� Page No. � �%�j�
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the appli ant the so legal or
of March 1, current year as of March 1, current year. equitable ner? O yes O no
If no, what is his/her ezact 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;
of mortgagee or contract seller
of mortgagee or
Name of Assignee or
Address of Assignee
seller
owner or holder of Mortgage.
R
' � Drawer NO.....
, ..............
N
n
Does applicant own real property If yes, what county? What Taxing Card 1\TO.
.........
............
in any other county in Indiana? %� ��/�� �ent
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COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year 0�- I Year � I Year ��__ I Year
� o� I Year a° I Year 1L
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Signature � �� Secretary of Board of Review Date
P P
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
�licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
��gnat re rs full name) Person authorized by duly executed Power of Attorney or
` / u%�� ^ . ��� by IC 6-t .1-12-.07).
of Applicant � � Address of Authorized Person