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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sure Form 43709 (RS I a-03)
PrescnGed by Department ol Local Govemmem Finance
INSTRUCTIONS: –File �rk
To be /iled in person or by mail with the County Auditor of the county whe�e the property is located. O C I L J ZOQ4
Filing Dates: 7) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effeyctive.
See reverse side (or additional instructions and qualifications. �y�.,/��
G��pt i�rv AUuITOft
(owne�orco` �cfbuyer-
\ CD �, � 1 �
Taxing Disirid U
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Assessed value of real property as of
March 1, currenl year
If no, what is his ! her exact share of interest?
4ions on reverse side) �
Key numb legal description
00 ��-oisa�-
Mortgage 1 Contrad indebtednes:
March 1, wrrent year
If name on record is different than thaf of applicant, indicate below:
��ne of moRgagee or contrad seller �/
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Record number
Page number
unpaid as of � Is the applicant the sole legal or equitabie
owner? �s ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrect selier (number and street, city, s--'—"O _
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 I If yes, what county?
county in Indiana?
s the property in question:
� F�661 Property ❑ Mobile Home QC 61.1-�
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Deduction approved in the amount of:
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20 O („ 20 20 ���`
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Signature Coun1
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��� We certify under the penalty of perjury lhal lhe abov�
sidenl of Indiana and owner of the aforementioned proN�,,, .
Signature (owners full nam�J
Person authon�,,,. _,
or by IC 6-1.1-12-.07
of authorized person
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