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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4/ 10-01)
Presaibed by Department of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: F'I Mr�
To be filed in person or by mail with the County Auditor o/ the county where the property is located. AU ��� L�2
Filing Dates: 1) Real Property: During the 12 months be(ore May f 1 of the year the deduction is to be e ect�ve.
2J Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 31 0( the r the ded tio `to 6 fle ive.
See reverse side for additional inst�uctions and qualifrcations. '� � ,-nq
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Applicant(ow rorcontra t uyer-see�tncti n nrevers side)
Tazin Disin� Key number / legal desc ' tion Re d number O� `.
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with who
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If name on record is different than that of applicant, indicate below: Is the property in queslion:
� Real Property ❑ Mobile Home (IC G1.1-�
�ame of mortgagee or contract seller �
Address of mortgagee or conlrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
counry in Indiana? property for wrrenl year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 20 20 20 20 f1� 20
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Signature County Auditor Date
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�I / We rtify under t e penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
a re ent of Indiana and owner of the aforementioned property on March 1, 20
i ature (owners full name) Person authorized by duly executed Power of Attomey
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Ful id nt a ess applicant Address of authorized person
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