Mortgage_Ferry (2)�N�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�� ��+ State Fwm 43709 (R6 / S-06)
Resaibed by Depanmem of Loral Gwemmerri Firiance �
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INSTRUCTIONS:
UY � � EVe�
To be filed in person or by mail with the CountyAuditor of the county whe�e fhe property is locat .
Filing Dates: 1) Real Property: During the 12 months before ,lune 11 0/ the yea� the deduction is to be elfe'cU�vey. �
2) Mobile Homes assessed unde� IC 6-1 J-7: Between January 15 and March 2 of t6�'�eti�r�cUon is to be eflective.
See �everse side foi additional instructions and qualifications. a1880N COUNTY AUDIT9f�
(owne� or y�qntra�t buyer -
Tauing Dislrid ///
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Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
If name on
Key num4er /
�—c8G
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MoRgage / Contrad indebtedness unpai as of I
March 1, curtent year ��� 7� �j� c
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If owned with someon other th
than that of applicant, indicate below:
mortgagee or contract seller
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Address of mortgagee or conVad seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
st2et, city, state, ZIP code)
Dces appliqnt own property in any
county in Indiana?
Deduction approved in the amounl
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Signature
Is the�
❑ Real
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t le
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Property �t#obil�Florrie QC Fr1.1-�
If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
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(
County Auditor
�
Date
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'/ We certify under the penalty of peryury that the above and foregoing informalion is true and corred and ihat the applicanls was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (oyvner�vjfull name) � Person authorized by duly executed Power of Attorney
X Full resi enj�ddress of applicant
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O�
or by IC 6-1.1-12-.07
person