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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Stete Form 43709 (R6 / 5-061
Presaibed by DepaNnent of Laal Govemment Finance
INSTRUCTIONS:
To be filed in person o� by mail with the County Auditor o! the county where the p�operty is
Filing Dates: 1) Real Property: Durrng the 12 months before ,lune 11 of the year the deduction is to be e(f�jive� g����
2) Mo6iie Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March 2 of the yeap�i � d�tlucti n �s to be e/fective.
See �everse side to� additional instructlons and qualificaUons.
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P,ssessed value of real
March 1, curtent year
If no, what is his / her exact
- see
as of
If name on record is different than that
of mortgagee or conVact seller
Key number / legal description
s src
Mortgage / Contract indebtedness unpaid as of
March 1,�rrent year
Address of mortgagee or contract seller (number
Name oT assignee or other owner or holder oi mortgage
Address of assignee (numbe�
street,
Does applicant own property in any otl
counry in Indiana?
Deduction approved in the amount of:
20� 20 O �
/
Signature
If owned with someone other
ci(y, state, ZIP
If yes, • ►7
Dra„�cr No...`.?�.L.......
-. . .
— Card NO. ...,�,�,1.3.�
. ........
-' �.��,�.�
20 �� 20 20
1
County Auditor
�
number
Is the applicant the sole legal w equitable
owner? Q Yes � No
❑ Real
spouse,
� Mab�e Home pC 61.
Has this deduction been requested on
property for wrrent year? Q Yes❑ No
20
Date
20
I I We ceRify under the penalty of perjury that the above and foregoing infortnatlon is We and conect and ihat Ihe applicants was / were
�sident of Indiana and owner of the aforementioned property on March t, 20
or by IC 6-1.1-12-.07
person