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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS / 4-03)
PrescAbed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ot the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months belore May 110l the year fhe deduction is to b��ct�ve; 2004
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the deduction is to be eHective.
See reverse side for additional instructions and qualifications. ��/ /j �%
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Applicant (owner r c tracf 6uyer - see re tricfions o verse side)
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Taxing Disirid Key n ber / legal description Record number �
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Assesse value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe appticant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhal of applicant, indicate below: Is the property in question:
❑ Reat PropeAy ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contracl seller �
Address of mortgagee or contrad seiler (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6erand street, city, stafe, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
20 20 G� 20 20 �� 20 �� 20 20
P P P
Signalure County Auditor Date
��/ We ify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
res ent of Indiana and owner of lhe aforementioned property on March 1, 20
ature (owners lull name) Person authorized by duty executed Power of Attomey
� � or by IC 6-1.1-12-.07
Ful ident address of p'cani Address of authorized person
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