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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS I 6-03)
P�escriEed 6y Department of Loral Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Ma
To be filed in person or by mail with the County Auditor o) the county where the property is located. S E P 2 9` 2���
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eNective.
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See reverse side /or additional instructions and quali(cations. �'/
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Applicant (own�or contract buyer -
nq Dislrid
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reverse side)
number /
Record number
Page number
Assessed value of real property as of Mortgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equital
March 1, curcent year March 1, cu t ar owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
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If name on record is different than thaf of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1
'me of mortgagee ar contrad seller
of mortgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved
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Signature
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in the amount of: �`;1,� e��yA _
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County Auditor
What Taxing District?
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Has this deduction been requested on
property for current yeaR � Yes ❑ No
20
Date
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certify under the penalty of perjury that lhe above and foregoing information is true and correct and that ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
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of
Person authorized by duty executed Power of Aftomey
or by IC 6-1.1-12-.07
Address o(authorized person