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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ / State Fortn 43709 (RS I 6-03)
� P2wiCM Oy Departmem of Local Govemment Finance
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INSTRUCTIONS: � � � .ile t�vlarl�
To be (led in person or by mail with the County Auditor ol the county whe2 the property is 1 ted. ��
Filing Dates: 1) Real Property: During fhe 12 months before May 11 0/ the year the deduction is to e eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 o/ the��Yfhe d_§dZ� is to be effective.
aee 2verse sioe mr aaamona� msrrucnons and quanncations. /
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Applicant (owner co uyer- see restn ' n rs ide) � u�c�v�r �wv i e�,! �vi ivr, i
Taxing District Key nu ber / legal descri n Record number �
� /� ._� ��- Q�/ Page number � ��
Assessed value of reai property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March �ent year owner? ❑ Yes � No
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If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is diHerent than that of applicant, indicate below: Is the pr erty in question:
❑ Real Pro�erty ❑ Mob1e Home (IC 61.1-7)
�me o mortgagee or contract seller �
Address of mortgagee or contract seller (number and street, city, state, ZIP
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Name of assignee or other owner or holder of mortgage �� ���
Address of assignee (number and street, ciry, state, ZIP code) � 11
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
counry in Indiana? property for curcent year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 O�P 20 �_ 20 �� 20 � 20
P � � P P �
Signature County Auditor Date
i I I We certify under the penalry of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
�esident of indiana and owner of the aforementioned property on March 1, 20
re (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu resident address of applicant Address of authorized person
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