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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESG
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4I 10-07)
Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: '
To be filed in person or by mail wifh the County Auditor o/ the county where the property is focated.
Filing Dates: 1) Real Property: Dunng tbe 12 months be/ore May 11 0( the year the deduction is to �/eCtiqe.2OO2
2) Mo6ile Homes assessed under IC 6-1.1-7: BeAveen January 15 and March 31 of the year t�e deduction is to be e/fective.
See 2verse side for additional instiuctions and qualifications. � /� /j /f
Applicant (ownerorcontracf buyer- see restnctions on reverse
Taxing District
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
If name on record is differenl
of mortgagee or contracl seller
of mortgagee or
number / legal
Record number
AUDITOfl
Page number / /
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom. �
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anl, indicate below: Is the property in question:
Name of assignee or other owner or holder of mortgage
city, state, ZIP
of assignee (num6er and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Districl?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amounl of:
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County Auditor
20
❑ Real Property ❑ Mobile Home (IC 61.1
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Has this dedudion been requested on
properiy for wrrent year?� Yes� No
20 � 20 �
1 �
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
leni of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person
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