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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
Prescnbed Cy Department of Local Gtivemment Financa
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where the property is
Filin Dates: 1 Real Pro e Durrn the 12 months before Ma 11 0/ the q�,.g� J 2003
g ) p rty: g y year the deduction is t b eRecWe
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the yea� the d/eduction is fo 6e eHective.
See reverse side for additional instructions and qualifications. �y��
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Applicant (owner or contract buyer - see restrictions on reverse side)
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Ta�cing Dis id y number / Iegai description Record number
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Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equltable
March 1, curtent year March 1, current year � 6,�0p• / ownef? �s ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicale below: Is the property in question:
�eal Property ❑ Mobile Home QC 61.1-�
'3me of mortgagee or contraIX seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code) ��:. ���q
Dra�r�er NO. •••!
Does applicant own property in any other If yes, what wunty? What' �ested on
county in �ndiana? Card NO. . •......•.... Yes❑ No
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Deduction approved in the amount of:
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Signalure County Auditor Date
�'/ We certify under the penalty of perjury lhal the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duty executed Power of Attomey
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Fu resi ent address of applicant / Address of authorized person
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