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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCT�ON FROM ASSESSED VALUATION ouyo� own ip Year
's ! SUta Fortn 43709 (RS / d-03) . . g �,_/
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� Pmsaibed Dy Depattment ot Loral Govemment Finance
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INSTRUCTIONS: �?`Y � �aric
To be filed in person or 6y mail with the County Auditor of the county whe2 the property is located.
Filing Dates: i) Reai Property: Ouring the 12 months before May 11 of fhe year the deduction is (g��ec�we�NTY AUDI70R
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 of the yearlhe deduction is to be effective.
See reverse side for additional instrucfions and qualifrcations.
I Taxing Disirid
oa
Assessed value ofrea
March 1, curcent year
see smc ons reverse s
Key number / legal description
�1fJ�-�39���
number
number
as of Mortgage / ContreU indebtedness unpaid as of Is the a,
March 1 rrentyear d� I �al/ 'y � owneR
�/� (1 � / �J -P -. �o
Ii no, what is his / her exact share of interest?
O..J
�
t the sote legal or
❑ Yes ❑ No
If owned wifh someone other lhan spouse, indicate with whom.
If name on record is difterent than lhat of applicant, indicate below:
�me of mortgagee or contract seller
Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
and sheet, city, state, ZIP code)
Does applicant own property in any oiher If yes, what county? What Taxing Distrid?
county in Indiana?
J 9 COUNTY AUDITOR
Deduct� \0.,����.:�•`��
D�•a��•er i .
�
� Card �0• ..... ............... Zo I zo
,, '
County Auditor
❑ Real Property O Mobile Home OC 61.1
nas �nis aeauaion oeen reques�ea on
properly for wrrent year? 0 Yes ❑ No
zo
Dale
zo
certify under the penalty of perjury that ihe above and toregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned propeAy on March 1, 20
fuil
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person