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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
:. w� I State Fwm 43709 (RS / 4-03) ,
� PrescnEeE by Depertment ol Laral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of tbe county where the property is locaie�. —
Filing Dates: 1) Real PropeRy: During the 12 montAs before May 11 of the year the deduction is to be eNective. A Y H () 7,n��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction rs to et' ective.
See reverse side lor additional instnictions and qualifications. �y,,
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Applicant
6uyer- see restridions o
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Assessedvalue of real property as
March 1, current year
If no, what is his / her exact share of
legal description
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bb��OQ8i8'� Pagenumber / /�
IOY�
Mortgage / Contrad indebtedness unppaid as of Is the applicant the sole legal or equitable
March 1, current year�` J v v✓`/�/ /�� owneR ❑ Yes ❑ No
If owned with someone olher than spouse, indicate wilh whom.
If name on record is different ihan that of applicant, indicate below:
'me of mortgagee or coniract seller ��
Address of mortgagee or contract seller (numb r and st2et, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number andstreet, city, state, ZIP code)
Dces applicant own property, in any olher I If yes, what county? What Taxing District?
county in Indiana?
�- � -
O � ' � � � a 1UNTY AUDITOR
2�
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1 �
County Auditor
20
Is lhe pi
❑ Real
❑ Modle Hmie pC 61.1-�
Has this deduction been requested on
property for current year?� YesO No
20
Dale
20
certify under the penalty of perjury that the above and foregoing information is irue and corred and that the applicants was / were
ent of Indiana and owner of the aforementioned property on March 7, 20
ie�§O� �rs (ull r��neJ� O Pery n authorized by duly executed Power of Attomey
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� VII1� CI\ orb IC6-1.1-12-.07
of authorized person
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