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`°rt�`° STATEMENT OF'MORTGAGE OR CONTRACT INDEBTEDNESS
�'' .� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S��y State Form 43709 (Ra I 70.01)
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� PreSCribeO try Department ol Loral Govemmeni Finance �
To 6eRfiled�'n�person or by mail with the County Auditor oJ the county where the propeRy is bcated� �� F'I�a�.Aar1i ►1
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Filing Dates: 1) Real Property: During fhe 12 months be%re May 11 of the year the deduction is to be effective.
2 Mobile Homes assessed under IC 6-1.1-7: Behveen Janua 15 and March 31 0l the e `� c{Fq`�a
1 ry y�rt�ll'e dedu s to be eflective.
See reverse side for additional instructions and quali�cafions. � , j� _ „
Applicant (o rorcontract buyer-see
Taxing Distri
on reverse
Key number / legal
Record number
�D 1-� 16$a- o� Page number
Asse ed value oi real property as of Mortgage / Contract indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year �� owner? ❑ Yes ❑ No
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If no, whal is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the pr erty in question:
eal Propeiiy O Mobile Home (IC 61.1-�
of mortgagee or conlract seiler
Address of mortgagee or contrad seller (numbe�and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
Does applicant own property in any olher I If yes, what county? I What Taxing Distrid? I Has this deduclion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
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09 : County Auditor
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Date
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certify under the penalty of perjury ihat the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of aufhorized person