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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
PresaiDed by Departmeni of Local Govemment Finance
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INSTRUCTIONS: � � � U F.il M
To be filed in person or 6y mail with the County Auditor of the county where the property is 1�ted. r� •
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to �e�e�e�tive. n�
2) Mo6ile Homes assessed under !C 6-1.1-7: Between January 15 and March 2 of the ee� t� �e��Tion is to be effective.
See reverse side for additional inshuctions and qualifications.
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Applicant (ow orCont c[ b yer - see retsMc1tions on �€'�i rse side) ' ,
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Taxin strict Key number / ie I tion Record number
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_ I�/� a\ Page number 9,73 3
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Assessed vatue of real property a of Mortgage / Contract indebt�ness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year �0 �� G O owne�? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
�e of mortgagee or contract seller
Address of moRgagee or contract 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 Districl? Has this deduction been requested on
counry in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
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PrA�sa� � � � P
Signature Counry Auditor Date
�� e certify under the penalty of perjury ihat the above and foregoing infortnation is true and conect and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners (ull name) Person authorized by duly executed Power of Attomey
. or by IC E1.1-72-.07
ull dent ad ss of app icant Address of authorized person
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