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�rt�'� STATEMENT OF MORTGAGE OR CONTRACT.INDEBTEDNESS
d � 4
�°— _"s FOR DEDUCTION FROM ASSESSED VALUATION
`� � State Form 43709 (R3 ! 10.00)
Presmbetl by Siate BoarO ot Taz Commissioners
Instructions for filing:
To be filed in person ar by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional instrudions and qualifications.
Applicant
Tauing District
on 2verse side)
Key number description
,F�
Count Township Year
[,i--, `• ; 'Fi e Ma� �+
� =\_.1 _s.._ .£�
DEf, � u tUui
Record number � /
�%�A D//`�0����� Pagenumber �a9�
�..CA—
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1 ent year owne(? ❑ Yes ❑ No
��,3 O�C
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
or contract seller
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
If owned with someone other than spouse, indicate with whom.
� u! /(
city, sfate, ZIP
Address of assignee (number and street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing Distrid?
other county in Indiana?
Deduction approved in the amount of:
��fr�iZ�Il�i�f�
COUNTY AUDITOR
20 Q,� I 20
�s �'�,l�z�$� I �'
Signature � County Auditor
Has this deduction been requested on
property for current year?� Yes� No
20 �
P
� rl.
�
'e certify under the penalry of perjury that lhe above and foregoing information is true and correct and lhat the applicants was / were
,,ident of Indiana and owner of the aforementioned property on March 1, 20 .
Signature (owners (ull name) • Person authorized by duly executed Power of Attomey
,n �1 . ,�� �j/J � % or by IC 6-t.t-12-.07
address of
II
of authorized person