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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
SUte Form 43709 (R4 / 70.01)
PrescnDeO Dy Departmenl ot Local Govemment Finance
INSTRUCTIONS:
To 6e �led in person or by mail with the Counfy Auditor o/ fhe county wheie the property is
Filing Dates: 1) Real Property: During the 12 monfhs belore May 11 0/ the year the deducfion is to�b� �ff2�t�e2�02
2) Mobile Homes assessed under IC 6-1.1-7� Behveen January 15 and March 31 of the year the deducl
See reverse side /or additional instructions and qualifications.
Appticant (owner
Taxing Distrid
see
Key number /
f� // -Oo y� 7-�
Record number
Page number
is to 6e e/%ctive.
�/
% (�
Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 7, current year March 1, nt year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
of mortgagee or contrect seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
assignee (number and street, city, state, ZIP code)
Does applicant own property in any other ( If yes, what county? I What Taxing Distrid?
county in Indiana?
2o b
COUNTY AUDITOR
approved in the amouni of:
20�� � 20�� � zo� � 20�1�
Signature � County Auditor
❑ Real Property ❑ Mobile Hane (IC E1.1-�
Has this deduction been requested on
property for cunent yea�? � Yes 0 No
zo 01 20 �3
Date � �
certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
of
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Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
of authorized person