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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS / 4-03)
P�esaiGeO Dy Department of Loral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the propeRy is located.
filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the deduction is to be effective. 1 1 20�3
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0) the ///ye���ar fhe deductio/n/.is to be eftective.
See reverse side for additional instructions and qualifications. �� 1 yj // n
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Applicant (owner or c ntract 6uyer - see restrictio on ers side)
Taxing District Key number /,legal description Record number
03-
D D I / d�3a-� Pagenumber D
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Assessed vatue of property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Property 0 Mobile Home (IC 61.1-7)
��ame of mortgagee or contract seller
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address ot assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
county in Indiana? property for curtent year? ❑ Yes ❑ No
COUNTY AUDITOR
DeducGon approved in the amount of:
2o zo o.r zo C 20 �Z zo _p� 2a �� 20
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Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that lhe applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20 .
nature (owner's lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu r idenl address of applicant Address ot authorized person
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