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INSTRUCTIONS: ���`Tj �p� "��t--� �iT le � rk
To be filed in person or by mail with the County Auditor ol the county where the property i$�otrat�tl. ��j J�
Filing Dates: 1) Real Property: Dunng the 12 monfhs 6e%re May 11 of the year the deduc�n is�lb n ective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of,thg,ye� � e��l�ction is to be eRective.
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate FOrm 43709 (R4 / 70-07)
P�escribetl by DeOaMient of Local Govemmem Finance
Coun Township Year
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Applican owner c ntract uyer-s restn�ionson�ev rs side) � _inSp^I .JU1�T" �������� �
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Taxing Distrid Key number / egal description Record number
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Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cu nt year (��, �� � owneR ❑ Yes ❑ No
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If no, what is his / her exacl share of interest? � If owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicant, indicate below: • Is the propeRy in question:
❑ Real PropeAy ❑ Mobile Home QC E1.1-�
Same of mortgagee or contract selier n�� �
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Address of moAgagee or contrad seller (number and street, city, state, ZIP
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any other If yes, what couniy? What Taxing District? Has lhis dedudion been requested on
counfy in Indiana? property for wrrent yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
20�_ zo� 2o�I� 2o zo� zo og za�_
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Signature County Auditor Date
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-� / We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident ot Indiana and owner of the aforementioned property on March 1, 20
' nat (owne�m� Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ull esid nt address of a plipnt �N Address of authorized person
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