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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� w� ♦ Stata Form 43709 (RS / 4-03)
P25cnbed by Department of Local Govemment Finance
C-oan ' � Township Year
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INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the CountyAuditor of the county where the property is located. �"lJe,<, ��,
Filing Dafes: 1J Real Property: Dunng the 12 months before May 11 o/the year the deduction is to be eflective. Q ��
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the year�dedr%�tion is fo be e�ective.
See reverse side for additional instructions and qualifications.
Applicant� (o�wq/ er or contract buy r- s�e 2st � ons on
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Tauing Distrid
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/� Key nyjYfber / le al escription Record number
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- - �j ���� � Page number� I C70�
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exaa snare of interes . If owned with someone other lhan spouse, indicate with whom.
If name on record is differeni than that of applicant, indicate below:
�e of mortgagee or contract seller �C\ �
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Address of mortgagee or contrad seller (number and stie@ , city, state, Z!P
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
7
Does applicant own propeRy in any other If yes, what counry? What Taxing District?
county in Indiana? �
ueauction approved in the amount of:
2� 20 �_ 20 �'
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Signature - ' � _ 2
COUNTY AUDITOR
20
County Auditor
20
Is the
❑ Modle Home pC 6�1.1-
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Has this deduction been requested on
property for wrrent yeaR 0 Yes � No
20
Date
20
certify under the penalty of perjury thal the above and foregoing information is irue and correct and thal ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire (owners full name) Person authorized by duly executed Power of Attorney
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of authorized person