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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
" FOR DEDUCTION FROM ASSESSED VALUATION
�. � � / State Fwm 43709 (RS / 4-03) . .
� Prescnbed by Department of local Govemmeni Finance
Coun Township Year
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INSTRUCTIONS: ���fM�l�$ ZOO6
To be filed in person or 6y mail with the County Auditor of [he county where the propeRy is located.
Filing Oates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the dedtic8�i�o�tiei� ctive.
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See reverse side for additional instructions and qualifications. p�gSON COUNTY AUDITOR
(ownerorcontract buyer- see restnctions on reverse side)
Taxing Disfrid
Asses�d value of real property as of
March current year
If no, whal is his / her exact share of interest?
Key number / legal description
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Mortgage / Contrad ir
March 1, current year
Record number
�
Page number
_o t 3
unpaid as of Is the applicant the sole legal or
owne(? f�es ❑ No
T
If owned with someone other lhan spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate below:
me o1f� mortgag(e�e or contrad seller
Q11 �I)e� � �' �„ 1.��
Address of mortg ee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder ot mortgage
of assignee (num6er and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Districl
county in indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20 n'7 20 Q8 20 �g_ � 20
P � P
Signature
County Auditor
20
Is the
❑ Mobile Home QC 61.1-�
Drawer NO. (?,y „—, % 3 9�
Card i\'O. —�
.....................
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Date
20
We certiy under the penalty of perjury that ihe above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
siaem awress or appucant Address of authorized person
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