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e rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-� "s FOR DEDUCTION FROM ASSESSED VALUATION
�, �. � Sla[e Form 43709 (R4 / 10.07) �
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�PrescribeG by Department ol Local Govemmeni Finance
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INSTRUCTIONS:
Coun Township Year
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F E BF.1� �a�p�3
To be filed in person or by mail with the County Auditor of the county where fhe property is located.
Filing Dates: 1) Real Property: During the 12 monfhs belore May 11 of the year the deduction is to 69 ct�ve. �%
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and March 31 of the year�f��de�d���om�s�UDBei�bve.
See reverse side for additional insbuctions and quali�cations.
Applicant wner or contract b r- see restrictions reverse side)
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Taxing Distrid Key number / legal description Record number
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes � No
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If no, what is his / her exact share of interesl? I owned with someone other than spouse, indicate with whom.
If name an record is different than that of applicant, indicate below: Is the property in queslion:
❑ Real PropeAy ❑ Mobile Home QC 6-1.1-�
"�me of mortgagee or contraIX seller
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Address of mortgagee or wntred seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in indiana? property for curtent year7 �] Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
i/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
•�esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners Iuli name) Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
F I resident address of appliqnt Address of authorized person
y