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ai "' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i`�: FOR DEDUCTION FROM ASSESSED VALUATION
�.��+ State Form 43709 (R6 / 5-06) �
� Presaibed by Department of local Govemment Finance
INSTRUCTIONS:
To be (iled in pe�son or by mail with the County Auditor of the county where the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6efore �une 11 of the year the deducGon is to be �ti�. _r, �D�7
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0( the ye r he educ �on is to be eflective.
See �everse side for additional instructions and qualifications. `�-ri� � t! _
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(ovmer or contract buyer - see
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Assessed value of real prope� as of
March 1, current year
,;
If no, what is his / her exad share of int
on reverse
Key number / legal description
a �-ao- �s-�oa- 000.
orY- o� a—
Mortgage / Conlrad indebtedness unpaid as
March 1, current year
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Rewrd number
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Page number � O !J. �
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f Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone ather than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of moAgagee or contract s II r • ��� n
N��
Address of mortgagee or contrad seller (number and sf2et, ciry, state, ZIP '� �
Name of assignee or other owner or holder of moRgage
Address of assignee (num6er and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county"r
county in Indiana?
Deduclion approved in lhe amount oE
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Signature
s lhe property
❑ Real Pmperty ❑ Mobile Home (IC 6-1.
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County Aw
We certify under the penalty of perjury that the above and f
resident of Indiana and owner of the aforementioned proper
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o�� e or cant Address of authorized person
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