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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS / 4-03)
PrnscnbeA by Department ot Local Govemment Finaxe
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: Dunng !he 12 months 6e%re May 11 0/ the year the deduction is to 6e:�ffe"ctive. ��t
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the�yger � t}�ctio�is to �ffective.
See reverse side for additional instnictions and qualifications. �
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Applica e`� c�tract buyer - see restncti on reverse side) � �(,/� l� ,�/
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Taxing Distrid Key number / legal description Recortl numtiei"��� 3
/(�jQ�(�� Q/� — � 06 3(p — 00 Page number G��/
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Assessed value of real property as of Mortgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, current year ownef? ❑ 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.
If name on record is different than that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horrie QC 67.1-�
me of mortgagee or contrad seller �— . f
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Address of mortgagee or contrad seller (number and st2et, city, state, ZIP (.
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 OTT 20 D lr 20 �_ 20 � 20 v` 20 20
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Signature County Auditor Date
�e Aify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
si nt of Indiana and owner of the aforementioned pr perty on March 1, 20
' at n�lul n e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F re dent address o i� t Address of authonzed person
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