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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R5/4-03)
PreSrnCed Dy Department of Local Govemment Finance
INSTRUCTfONS:
To be filed in person or by mail with the CountyAuditor of the county whe�e the prope is
Filing Dates: 1) Real Property: During the 12 months be%re May 17 0! the year the deduction ��6��cf�5
_ 2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o e y ar he deduction is to be effective.
See reverse side for additional instructions and quali�cations.
�a� �`�
(owner ory6�t2ct buyer- see
Taxing District
an reverse side)
Key number /
Record number
Page number ✓
a D�- G�33/-oa
Assessed value of real properiy as of Mortgage ! Contract indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
� I O,oOa
If no, what is his / her exact share of
If name on record is differo^�'�°- "-'—" "
'�me of mortgagee or coi —�Zy"� tt 1i s.�.
"""' - J I�
Address ot mortgagee or c �'"� Q"� �k� �?'
Name of assignee or other ��2� ,� h�
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Address ot assignee (numt I �I a�5
I( owned with someone other than spouse, indicate with whom.
Does applicant own propert� �� C�/� Q/� ���p l((Y
counry in Indiana? �J �'�
Catrle..n to-�cn �o-�I-�T�T.
Deduction approved in the amouni
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20 � 20 20
P
County Auditor
ig District?
s the property in question:
❑ Real Property ❑ Mobile Home pC 61.
Has this dedudion been requested on
property for curtent year7 � Yes ❑ No
20
Date
�
�We certify under the penalty of peryury thal lhe above and toregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorizzd person