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�ee `� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION
J S1ate Fortn 43709 (R6 / 5-06)
� I� Presaibed by DepaNnent of lorvl Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audifo� of the county where the property is locater.
Frling Dates: 1) Real Property: DuAng the 12 months 6efore ,lune 17 of the year the deduction is to be elt�q�e� 6 ZOOI
2) Mo6ile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 of the year�iA� e uction is to 6e elfectrve.
See reverse side fo� additional insWCtions and quali/ications. �� ��
- ,.,,uuTY AUDITOR
Applicant (owner
Assessed value of real property
March 1, wrrent year
see
16no, what is his / her exact share of interest?
If name on
that
mortgagee or contrad selier
Key number / let al description Record number �
� lY�l�� (0 OY/ ��iJlJI �� �umber VJ�
Mortgage / Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
March 1�rrent year owner? ❑ Yes 0 No
/3S Do�
Ii owned with someone other lhan spouse, indicate with whom.
indicate below:
Address of mortgagee ar conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, sfate, ZIP code)
Does applicant own property in any olher If yes, what county?
county in Indiana?
Deduction approved in the amount of:
Zo ��
Signalure
��1��
s the property in questfon:
❑ Real PropeAy ❑ Mobile Home QC 61.
What Taxing District? Has this deduction
property for cunent
COUNTY AUDITOR
��iuKR �m��
20 mrc.�4 A�� w
County Auditor
��- (�53�i
0
iestetl on
Yes❑ No
We certiy under the penalty of peryury that the above and foregoing infc ts was / were
residenl of Indiana and owner of the aforementioned property on March t, 20
�n ll name) Person authorized by duty executed Power of Attomey
(� �^/'\ or by IC 6-1J-12-.07
ant IAddress of authorized person
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