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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNEcc
FOR DEDUCT►ON FROM ASSESSED VALUATION
State Fortn 43709 (R4 / 10-01)
Presui�e0 Dy Depanrtren� W Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the property is /ocate�A N� 0 20�3
Filing Dates: 1) Real Property: During the 12 months belore May 11 0l the year the deduction is o 6e etTecfive.
2) Mobile Homes assessed under IC 61.1=7: Behveen January 15 and March 31 of the ye7r th�e./d�eduction i-to be eHective.
See 2verse side /or additional instructions and qualifications. ��! �',c�.��
� �' GIBSOP� COI�� � � zUDITOR .
Applicant
Taxing
Assessed value ofre:
March 1, current year
- see restri�tiorl¢ on reve,�se side)
as of
Key number / legal description
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oAgage / Contrad indebfedi
March �rrent year
number
Page number
as of I Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? � If owned with someone other than spouse, indicate with whom.
- 3- 9�aa -66a. 3a�-��
If name on record is different than thaf of applicant, indicale below: Is the property in quesiion:
❑ Real Property ❑ Mobile Hane (IC Cr1.1-�
�me of moAgagee or contrect seiler
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Address of mortgagee o n ad seller (number and street, city, state, ZIP
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assignee or other owner or holder of mortgage
Address of assignee (n�mber and street, city, state, ZIP
Does applipnt own property in any other I If yes, what counry? I What Taxing Distrid?
county in Indiana?
Deduction approved in fhe amount of:
20
Signature
r � r ��i]
I► . 4 •
COUNTY AUDITOR
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County Auditor
20
Has this deduction been requested on
property for curtent yeaR � Yes ❑ No
20 � 20 �'
� �
Date
I���d I
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
of authorized person
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