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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 ihe
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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JUL 0 � 1999
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Applic (O r or�t�t,kfuyer - s restrictions on reverse)
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Taxing District Key Number/Legal Description Record No. �
� V�! -{�� 7%-D �i Page No. l�g�J
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as. of March 1, current year. 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:
. Name of mortgagee or contract seller ��U/�!
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ddress of mortgagee or contract seller `
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own !eal 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 19abj� �_�� t-9- � �� 19� 200� yg��
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Signature _ Secretary of Board of Review Datea p��-� ,z,00q - P
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IIWe certify under penalty oi perjury that the above and foregoing information is true and correct and that the appli-
�-�nts was/were a resident of Indiana and owner oi the aforementioned property on March 1, 19
nat re (owners full am�) Person authorized by duly executed Power of Attorney or
' by IC 6-1.1-12-.07).
Full R dent Addre Aplicant � ddress of Authorized Person