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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION CQ n �.ow Year
�. � J State Fwm 43709 (R5 / 4-03)
� PrestribeA by Department ot local Govamment Finance.
MAR 0 5 Z007
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the CountyAuditor of the county where fhe property is located. �y�� �� �
Filing Dates: 1) Real PropeKy: Dunng fhe 12 months belore May 11 0( the year the deduction is to 6e elfecffva
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( tl�e���pfl�, ,�qsti�@IimFe eHective.
See reverse side for additional instnictions and qualifications.
crouyer-see
Taxing
Assessed value of real property as of
March 1, current year
Ii no, whal is his / her exact share of inleresl?
If name on record is different than that of
mortgagee or wntract seller
ons on
Key number / legaldescripti n Record number
a1v-�l-oq-3oo-0o �R7�8-o�7 �
/i�l/ l {��� / X _ /f�l Page number /
(�-i�l� CJ U V V tp
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legat or equitable
March 1, current yeaf owneR ❑ Yes ❑ No
/
C (%
If owned with someone other than spouse, indicate wilh whom.
indicate below:
�,�lu,�
�
N� �� pC.Ey .�.�s A- T
Ac
Dc
�
� 7Sd(�
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Taxing District?
20
s the property in question:
❑ Real Property ❑ Moble Home (IC Cr1.1-�
Has this dedudion been requested on
property for current yea�0 Yes❑ No
20
Date
�
�rmation is true and correcl and that the applirants was / were
. resident ot Intliana and owner of the aforementioned property on March 1, 20
Y Signature (owners (ull n me) Person authorized by duly executed Power of Attomey
/I
� � n�g �{.� '� n,nQ� Q,� or by IC 6-1.1-12-.07
� I F\uil^esident aAdress o( applicant (� ^ IAddress ot authorized person