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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS I 4-03)
PresoiGed by Depertment of Local Govemment Finance
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. ����� �
Filing Oates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be efrecti ��
2J Mobiie Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the duct n i to e eftecti e.
See reverse side for addifional instructions and qualifica[ions. Q � T 1 7 2�03
(owner or contract 4vyer -Isee restnctions on
Taxing D' trict // a I Key nurttber % legal description I Record number ��""" '
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Assessed value of real pr erty as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currentyear March t, currentyear O owner? ❑ Yes ❑ No
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If no, what is his I her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contract seller /� „ /� `
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Address of mortgagee or contrect seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
20
COUNTY AUDITOR
approved in the amount
20 Q� I 20 �%� I 20 (/-/
T
County Auditor
s the property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1-7)
Has this deduction been requested on
property for current year? ❑ Yes ❑ No
20 0 � 20 �� 20
P �
Date
certify under the penaity of perjury that the above and foregoing information is true and corcect and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
1 � 1 Y.r�x
Person aulhorized by duly
or by IC 6-1.1-12-.07
person