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i� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�r FOR DEDUCTION FROM ASSESSED VALUATION Count WTownsTThip Year
.��:.... � -i' Su1e Form 43709 (R6 / SA6) .. . � � �
Presm6ed by Depanment of Lonl Govemment Finance
�
INSTRUCTIONS: O CFT1e���OU I
To be filed in person o� by mail with the CountyAudito� o/ the county where the property is located. �y,,
Filing Dates: 1 J Real PropeRy: During the 12 months belore June Il of the yeai the deduction is to be eflectiveO'� �
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the year �h��r�tt������ve.
See reverse side /or additional instructions and quali(ications.
(owner
Tauing Dislrid
see
Assessed value of real property as of
March 1, wrreM year
If no, what is his / her exad share
reverse side) •
Key number / legal
Mortgage / Contrad ir
March 1, wrrent year
�01 UU[
If name on record is different than that of applicant,
me of mortgagee or conVad seller �-.
.(��
Address of moRpagee or conVad seller (number ai
Name of asaignee or
Address
owner or
and street, ci;
Does applicant own property in any other I I�
county in Indiana?
Deduction apprwed in the amount
20
Signature
Record number
1�7/ _Y.�gGpumber 3 1 �
310 E.CJ �+
unpaid as of Is the applicant the sole legal or
owner? ❑ Yes 0 No
If owned with someone ather than spouse, indicate with whom.
st2et, ciry, state, ZIP
Dra�ti�er iVp,� _ ��,yZ
Card NO . .....................
O'�� �30 CUp, o0
COUNTY AUDITOK
20 U� I 20 /� I 20 20
!
County Auditor
Is the properiy in question:
❑ Real Property ❑ Mobile Home QC &1.
Has this dedudion been requested on
property for cunent yea(? � Yes � No
20
20
We certify under ihe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person