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�i �� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
's'�',= FOR DEDUCTION FROM ASSESSED VALUATION t To ip Year
�J • SUte Form 43705 (R6/5-06) - . .
�'� Presoibed by Departmem of local Govemment Finance �p � 2008
INSTRUCTIONS: ���j�
To be filed in person or by mail with the County Auditor of the county where the p�operty is located. G S N COUNTY AUDITOR
Filing Dates: 1) Real Property: Dunng the 12 months before �une Il of the year the deduction is to be ei�ecQve.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 o/the year the deduction is to 6e eNective.
See reverse side for additional instructions and qualifrcations.
Applicant wnerorcont�act buyer- se restriction on reverse side)
Taxi g Distrid Key number / legal description Record number
� ot�-l3- /9-aoa - 000. �aD 7
� a _ OO r Page number ���
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as,of Is the applicant the sole legal or equitable
March 1, curtent year March 1, wrrent year owneR ❑ Yes � No '
�Ib, 3 go
If no, what is his / her exad share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in question:
� Real Rnperty ❑ Mobile Hmie pC 61.1-�
�e of mortgagee or conVad seller -
Addreas of mo ' agee ar conVad s�er (number and street, dty, state, ZIP ��' ��
ab07- � .4
Name of assignee or other owner or holder of mortgage �� I':1��' CI' � �•-••••" '���
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Address of assignee (num6er and st2ef, city, state, ZIP code) �� / I�pb ��fr"'l
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Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for wrrenl yeaf� � Yes❑ No
COUNTY AUDITOR �
Deduction approved in fhe amount of:
1
2o�g 20 1 20 20 20 20 20
P P
Signature County Auditor Date
We certify under lhe penalty of perjury lhat the above and foregoing information is true and corted and ihat the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
Si nat re (owners full na e) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
ull resi ent address of applipnt Address of authorized person
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