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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �w� / State Fortn 43709 (RS / 4-03)
PrescriDed by Department of Loral Govemment Finance
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INSTRUCTIONS: ile Ma�
To be filed in person or by mail with the County Auditor of the county whe2 the propeRy is located. �� �
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 0/ the year the deduction is to be lfecti �e.�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year fhe deduction `�be�tive.
See reverse side for additional instn�ctions and quali�cations. .�i�N � 2 2004
or contract buyer - see
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Taxing Distric)/
P�-�,�q i�
value of real property as of
March 1, wrrent year
Ii no, what is his / her exad share
nons on reve se sl�
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Key number / legal
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Record number
Y AUDITOR
03
�d� _� 3� 6 z_ a d Page number p� � O
-i a
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate
mortgagee or contract seller �/��
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Address ot mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other if yes, what counry? I What Taxing District?
county in Indiana?
Deduction approved in the amount of:
20 0�r 20 O� 20
1 Y
Signature
COUNTY AUDITOR
20 ��/ 20�
T
P
County Auditor
s the property in question:
❑ Real Property ❑ Mobile Horrie (IC 61.1
Has this deduction been requested on
property for current year? � Yes � No
20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on MarcFi 1, 20 �
(ownels (ul{.qame) Person authorized by duly executed Power of Attomey
V% , �% or by IC 6-1.1-12-.07
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of authorized person