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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�+ � - State Fortn 43709 (RS / 6-03)
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Prescn�ed �y Department ot Local Gpvemment Finance
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INSTRUCTIONS: � � . File Mark�i"�
To be filed in person or by mail wdh the County Auditor of the county whe2 the propeRy is located. �a� ��+�
Filing Dates: i) Real Property: During the 12 months be%2 May 11 0/ the year the deduction is to be eflective U V
n COUNTY qUDITOR
� �-, � 2) Mo6ile Homes assessed under IC 6-1 J-7: Between January 15 and March 2 0l t6e year �A�7�P'i�ucTwn �s to be e/%chve.
See 2verse side for additional instnictions and qualifications.
- see restrictions on re�verse side)
number / legal description � Record number
� � I � � Page number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year .- owner? ((]�i'es ❑ No
�r ti �a
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than fhat of applicant, indicate
of mortgagee or contrad seller
Address of mortgagee or contraG seller (number and st�eet, city, state, ZIP
Name of assignee,or other owner.orholder of mortgage
Address oi assignee (number and street; ciry, state, ZIP code)
Does applipnt own�property in any other I� yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 20 �_
P P
❑ Real Property ❑ Mobile Home (IC 61.1-�
0 N � �e
Dra�r�er NO..... 3`��c}po,
S' 17- O5'
What TaxiCard N0 . .....................
7_oas— 3��Z
'� L� COUNTY AUDITOR
20 U� 20 20
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County Auditor
20
rZi7
�uesled on
� Yes❑ No
We certify under the penalty of perjury fhat the above and foregoing intormation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�n tu�e (owners full name) Person authorized by duly executed Power of Attomey
. _����� , Q ������_ or by IC 6-1.1-12-.07
person