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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stete Fartn 43709 (R6 / 5-06)
Presaibed by Department of Loral Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe County Audito� of the county whe�e fhe p�operty is located. ��p
Filing Dates: 1) Real Property: During the 12 months be/o�e June I7 of the yea� the deducfion is l0 6e eff'ec"ZVe.2 1 ZO��
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year�t-hye,,deduction is to be eltectrve.
See reverse side for additional instruc6ons and qualificaiions. d'(a�+ ��y
tl16�pN CO� TY A OITOR
Appli t(owner or contract buye� - see restn'ctions on �e e�se side) �
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Ta ' g DisUict Key number / legal description Record number U/
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Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year E y owner? ❑ Yes � No
�'s o0o Q$,a't�.�
Ii no, what is his / her exac[ share of interest? IT owned with someone other Uian spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the operty m estion:
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�; of mortgagee or contract seller /� � .� �� rn�S� S
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Address ot mortgagee or contract seller (number and s6eet, city, state, ZIP D A�s %n �
Name of assignee or other owner or holder of mortgage o1_' 1���
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Address of assignee (numbe� and stieet, city, stafe, ZIP code)
Does applicant own property in any other Ii yes, what county? What Taxing District? Has this deduc6on been requested on
county in Indiana? property for wrrent year? QYes❑ No
COUNTY AUDITOR
Deduction approved in the amount oL
20 �� 20 O� 20 �_ 20 20 20 20
P P P
Signature County Auditor Date
I/' e certify under the penalty of perjury ihat the above and Toregoing information is W e and correct and that the applicants was J were
ient oi Indiana and owner of the aforementioned property on March 1, 20 .
S�y tJre (owner I a e) Person authorized by duly executed Power of Attomey
�� � or by IC 6-1.1-72-.07
FLII resid t address of ap ' nt Address of authorized person
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