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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Form 43709 (R / 12-99j
Prescri�ed by State Board ot Tan Commissioners
Instructions for filing:
To be filed in person or by mail with the Counry Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional instrudions and qualifications.
Applicant
Districl �
��
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
tion on/reverse side) ,
V"
Key number / legal desc
Ol �'-�a
Mortgage / Contract ind�
March 1, current year
If name on record is different than lhat of applicant, indicate
�ame of mortgagee or conlracf seller
1 � I .
Address of moRgagee or contract seller (number and s et
FORM 5
Filing fee 51.00
Coun Township Year
�
MAR 16 F2001a�k
GIB/�NTY AUDITOR
Record number Q
Page number � � � �
unpaid as of I Is the applicant the sole legal or equitable
,owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own real propeRy in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaR 0 Yes❑ No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
r� � �i
c I-13'b�
+�/ii��iZ�' � •
Signature sj(g� 0 pY � Secretary of PTABOA
Y F
20 �� 20 � �
/ /
Date
I/ We �iify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
1 re dent of Indiana and owner of the aforementioned property on March 1, 20
full name)
Person authorized by
or by IC 6-1.1-12-.07
Fu0ll resident ad eSsbf applicant �n' Address of authorized person
p �s ���dl/Yn.an.� Y�GiYI 1-1 ?(o %O
of Attomey