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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
°+ w� / State Fortn 43709 (RS / 4-03)
� PresaiDed by Department o( Lotal Govemment Finance
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INSTRUCTIONS: k� � i� rF e Mark�
To 6e (led in person or by mail witA lhe CountyAuditor of the counry where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to 6e�eflactiYe� 20�1�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tAe dedu�c�tion is to be effective.
See reverse side for additional instructions and qual�cation . ( r{, ///� f%'1
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�Applicant(owneror /itra f e s re '
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Distrid
Assessed value of real property as of
March 1, curtent year
If no, what is his / her exad share of interest?
Key number / legal description
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Mortgage / Contred indebtednes:
March 1�nt year
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If name on record is different than that of applicant, indicate below:
of mortgagee or contraIX seller
Record number
Page number �' / � � /
5" 7
Is the applicant the sole legal or equ
owneR ❑ Yes ❑ No
unpaid as of
If owned with someone olher than spouse, indicate wilh whom.
Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
s the property in question:
❑ Real Property ❑ Mobile Hmie (IC 61.
Does applicant own property in any other If yes, what county % �" Taxing DistriG? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes � No
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Deduction approved in the amounl of: Card NO .� p y� 'z y% (.
./'
20 20 20 �� 20 � •. _ 20
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County Auditor
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/ We certiry under the penalry of perjury that the above and foregoing information is true and correct and that the appiicants was / were
resident of Ind' na owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
Haaress oi aucnonzea person
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