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e�'� .� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Yea
',«.
/ State Fwm 43709 (R6 / 5-06)
� Presaibed by Depertment of Loc21 Gwemment Finance
INSTRUCTIONS: � � �M�
To be �led in person o� by mail with the County Audito� o! the county where the property is locate . �� �J ���
Filing Dates: 1) Real Properly: During the 12 months before ,lune �1 of the year the deduction is to be��Q c' e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeaFM��d�jc(�Q� to be effective.
See reverse side for additional instructions and qual�cations.
�a� ��
Applicant (owner or
Taxing District
Assessed value of real property as
March 1, current year
see resmations on
number
Record
number
Mortgage / Contrad indebtedness unpaid as of Is the ai
March 1.�irrent year owner?
�j
�ai
t the sole legal or
� Yes � No
%���C �
Ii no, what is his / her exact share oi interest? If owned with someone other than spouse, indicate with whom.
��- ►--�,
name on recorc
mortgagee or
-103-ool.a�sa
Terent than that of applicant, indicate
Address of mortgagee or contract
or other owner or holder of mortgage
�
Does applipnt own property in any other I
county in Indiana?
state,
�
�� i�s hs�,�.
��� ��- ;
�ov7- a a r� ��_
COUNTY AUDITOR�
)eduction approved in the amount of:
20 0 20 �_ 20 O C{ 20 20
P P �
Signature County Auditor
Is the property in question:
❑ Real Properry � Mob7e Home QC G1.1-7)
Has this deduction been requested on
property for current yeaR � Yes❑ No
20
Date
20
1 I We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
�.sident of Indiana and owner of the aforementioned property on March 1, 20
: . •
I�
or by IC 6-1.1-12-.07
person
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