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e � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�"' ' FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
���, State Form 43709 (R4! 10-01) . .
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� Presaibee by OeDarMenl W Local Govemment Finance �� �� ��ji
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INSTRUCTIONS: MAY O �����
To be (led in person or 6y mail with the County Auditor of fhe county where the property is located. q
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 of the year the deduction is to'be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 o(�the year_the dedu�ction is to be eNecfive.
See 2verse side lor additional instructions and qualiFrcations. GIESp�d COL" TY NUDITOR
(owner or contract buyer- see restrictions on reverse side)
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Tauing Dt�rid "
' �or+ Brarch
Assessed value of real property as of
March 1, wrrent year
no, what is his / her exacl share of interest?
Key number / fegal description
' Oil-�osg9-oc�
March 1, wrrent year
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Record number
�0�3 �
Page number
3 `6 '
unpaid as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone olher than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below:
,me of mortgagee or contrad seller
In� ���. ��.k u.A�
Address of r[gagee or conlrad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other I lf yes, what county? I What Taxing Districl?
county in Indiana?
20 d. 4
Signature
approved in the amount of:
20
COUNTY AUDITOR
20 Q�_ 20 O 4 20 QI
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County Auditor
Is the property
❑ Real PropertY ❑ Mobile Home (IC 51.1
Has this dedudion been requested on
property for current year?� Yes❑ No
20 �� I ZD �_
�
Date
I/ We certiry under the penalry of perjury lhal the above and foregoing information is true and corred and that the applicants was / were
�i resident of Indiana and owner of the aforementioned property on March 1, 20
>ignat�ur'e (ow� e� Person authorized by duly executed Power of Attorney
,� . J or by IC 6-1.1-72-.07 � -
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Address of authorized person