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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�> ♦ State Fortn 43709 (RS / 4-03)
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PresaiDaE by Department ot Loral Govemmeni Finance
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INSTRUCTIONS: File Ma.rk ,
To be �led in person or by mail with the County Auditor of the county where the property is located. -�
Filing Dates: 1) Real Property: Dunng the 12 months befo�e May 110/ the year the deduction is to be effecti� �� V? 1 t: /U'I3
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year fhe �educt�on �s Yo 6e effective.
See reverse side for additional instructions and qualifications. �` � �� n/f
Applicant (owner or conjract bpye� see
Assessed value of real property as of
March 1, current year
no, what is his / her exact
Key number / legal description
a4 - 0
Mortgage / Contract inj
March 1, current year
� Record number
0 �1 Page number
�r
� as of Is lhe appli
owner?
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t the sole legal or
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
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If name on record is different tFian that of applicant, indicate below: `
�ie of mortgagee or contract seller
Address of mortgagee or contract seller (number and stree , city,�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what counry? What Taxing District?
county in Indiana?
Deduction approved in the amount o i� �/�,
e)
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ri , �i
COUNTY AUDITOR
�
County Auditor
20
s the property in queslian:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
Has this deduction been requested on
property for current year? ❑ Yes 0 No
20 � 20
1
Date
certify under the penalry of perjury that the above and foregoing information is true and cortect and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
�e (owners(f�ull name) n f Person authorized by duly executed Power of Attomey
_ �_ ((1\ 1 �. \\ I�A ., S..c�_ i or by IC E1.1-12-.07
of
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person