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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION �f ',7 Township, Year
�t � � Slate Form 43708 (R4 / 10-01) � �
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� Prescribe0 by Departmznt ol lxal Govemment Finance ^
INSTRUCTIONS: File�Mark
To be filed in person or by mail wifh the County Auditor ol the county where the pioperty is located. ��J
Filing Dates: 1) Real Property: During the 12 months before May 11 olthe year the deduction is to�be effective �JpUhTY AUDITOR
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deduction is to be eHective.
See reverse side !or additional inshuctions and quali�ca6ons.
or contract buyer - see
Taxing Distrid
Assessed value of real property as of
March 1, wrrent year
-no, what is his / her exad
of
on
number
side)
Record number Q
O��_ /l/.,/ �4_ !n\ Page number
d./lLl(p ! UCJ
MoAgage / Contrad indebtedness unpaid as of Is the ap�
March 1, wrrenl year /��' �� �. owneR
)�l. �
If name on record is different ihan that of applicant, indicate below:
of moAgagee or contrad seller � n -
t tfie sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address o( mortgagee or conVad seller (number and street, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Dces appliqnt own property in any other If yes, what county? I What Taxing Distrid?
county in Indiana?
Dedudion approved in the amounl of:
20 D 20
� �
Signature
COUNTY AUDITOR
r�/l�f'3:
Countyl Auditor
r� .'
❑ Real Properly ❑ Mdile Hane pC 61.1-
I Has en�� a-' - _
Y.�.:� /• �.? ,•.
Dra��'er NO.
....
Card NO . .................
-� �
�
Date
20
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that Ihe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March t, 20
��� � ��
�esident a dress of appliqnt
07 .�. ����,�ti L4.,�
Person authorized by duly executed Power of Attomey
o� by ic s-�.�-�z-.o�
ofauthorized person