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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed 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
property is located during the 12 months before May 11 of the year the deduc
is to be effective. See reverse for additional instructions and qualifications;'
Applicant (Owner or
District
buyer - see restrictions on reverse)
Key Number/Legal Description
� 1999
Record No.
—� ��(/ �� d V I Paae No. .
Assessed value of real property as Mortgage/Contraci Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes I7 no
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 thai of applicant, indicate below:
of mortgagee or contract
of mortgagee or contract seller
or other owner or holder of Mortgage.
Address of Assignee
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Does applicant own real property If yes, what county? What Taxing District? Has this deduciion been
in any other county in Indiana? requested on property for current
year? ❑ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19_� . 19� bD2 lg d�
Signature
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Secretary of Board of Review
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Date o D r, �p
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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
iture (own fu e) n Person authorized by duly executed Power of Attorney or
�.._ _. ., w � . �� �l .. _ � .._ _ J by IC 6-1.1-12-.07).
Address of Aplicant I Address of Authorized Person