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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4 ! 70-07)
Prescribed by Department of Local Govemment Finance
Count Township Year
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o( the county whe2 the property is located. F E B 1_ Z0�2
Filing Dates: 1) Real P�opeRy: Dunng the 12 months betore May 17 0l the year the deduction is to be e/fective. �
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0% the year the deduction is to be eKective.
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See reverse side loradditional insWctions and qualifications. i ^J i��
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A t(ownerorcpnt stnction n er si
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axing Disfrid ey number / legal description Rewrd number y� �
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Assessed value of real propeAy as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1 currenl year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
�ie of moAgagee or wnlrad seller
Address of mortgagee or contraIX seller (number and 5t2 city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
couniy in Indiana? property for currenf year?0 Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 �L,\ � 2o LJ � 2o zo Q� 2o D� 20 �� 2o b� 0%
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Signat re County Auditor Date
�'Ve certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duiy executed Power of Attorney
��� or by IC 6-1.1-12-.07
ull resident address of pplicant Address of authorized person
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