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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION T P Year
�• ! Sute Form 43709 (RS / 4�03)
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PrespiheE by Department of Local Govemment Finance
fNSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. `�jj ��
Filing Dates: 1) Real PropeRy: During the 12 monfhs be(ore May 11 0/ the year the deduction is to b� e{fer�e.
2j Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 ok�gg@61rQ/f3tN�TiGdh'�Ai�Q�be eflective.
See reverse side lor additronal instructions and quali�cations.
Applicant wner or confracf buyer ee restriFtions on reverse side)
Taxing Distrid Key number / legal description Record number ��
�� � � I � ,� � ��� J Page number �
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 7, current year March 1, current year owner? ❑ Yes ❑ No
1
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 ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobiie Home pC 61.1-�
�.me o( mortgagee or contrect selier
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Address of moAgagee or contract seller (number an treet, city, state, ZI
Name o( assignee or other owner or holder of mortgage
Address of assignee (number and sf2et, ciry, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
county in Indiana? _ property for wrrent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 Qt 20 . n4i � 20 �� 20 20 20 20
1 � �
Signature County Auditor Date
� We certify under the penalty of perjury ihat the above and foregoing information is true and corred and thal the applicants was / were
a resident of Indiana and owner he aforementioned property on March 1, 20
S' n ture (ow r full n�me) � Person authorized by duty executed Power of Attomey
� � or by IC 6-1.1-12-.07
F resident address of applicant Address of authorized person
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