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��' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS `
' = FOR DEDUCTION FROM ASSESSED VALUATION Count _,.: Township Yearti
` �' . � � State Form 43709 (R4l 10-07) -� ;, � �}' ��A �
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� Prescribe0 by DeDanment o( local Govemment Finance ,lY
INSTRUCTIONS: �UL 1 � � _ Il
File M
To be filed in person or 6y mail with the County Auditor o/ the county where the property is located. � ����
Filing Dates: 1) Real Property: Dunng the 12 months befo2 May 11 0l the year the deduc6on is to be�ef/echve: "`";T}
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma�cti�3l�of the ye�ar tlfe deduction is to be effective.
..�act,.�. -
See reverse side /or additional instructions and qualifications. � �
A licant (ovmer or contracf buyer - s
� �
Tauing Dis nd
MP�_�.1� �
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exad share of i
reverse
Key numbeT�fegal description � Record number _��
U
Page number
� - 0'-1 - cd
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? �es ❑ No
�/ � Oo6
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
moAgagee or contrad seller
�,0� v � �� L° �I
ot m gagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and st2et, city, state, ZIP crode)
Does applicant own property in any other If yes, what county? What Taxing Distrid?
counry in Indiana?
approved in the amount
20
Signature
COUNTY AUDITOR
FZ�7/L�� ' �'
County Auditor
� J�
� � '.
LWieal Properiv ❑ Mobile Home pC 6�1.1
Has this dedudion been requesled on
property for wnent yeaR 0 Yes ❑ No
Date
20
/ We certify under the penalty of perjury that the above and foregoing information is true and coned and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
full
Full re ' ent address of 9pplipnt Q
`t �7.�r,�aaa �ra nc.i sc
Person authorized by duly executed Power of Attomey
or by IC 61.1-12-.07
of authorized person