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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
StaIBFOrm43709 (R6l546)
Presvibed by Depanment of Loral Govemment Finance
INSTRUCTIONS:
To be filed in person o� by mail with the County Auditor of the county where the prope�ty is
Filing Dates: 1) Real Property: Du�ng the 72 months before June I f of the year the deduction is to b����ve. �
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 of the d�d is to be effective.
See reverse side for addifional instnictions and quali/ications. � �
�
Applicant (owner or contract buyer --s s ictio s on verse si e)
Taxing District y number / legal �s�rip�yi Record number
/� ��/..� (c-f.C�
_!� �iy��, _ _ l� ��y'�0 ��Y��—��:'�%/ genumber
(1f�1L\) � e
Assessed value of real property as of
March 1, current year
March 1, r,u_rrent year
as
! d�
t the sole legal or equite
� Yes ❑ No
� �� 0 V
If no, what is his / her exact share oi interest? If owned with someone other than spouse, indicate with whom.
IT name on record is different than that oi applicant, indicate below: Is the properly in question:
❑ Real Property � Mobile Home pC E1:
�e of mortgagee or contract seller �
Address of moRgagee or contract seller (number and street, ity, state, ZIP
Name oT assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, LP code)
Does applicant own ^�� ��-anv.other_I If_ves,.what counry? I What Taxing District?
county in Indiana? �
' Dra�vcr NO....°.�.�
...
L�a� ,uoiTOR
Ca►•d i\'O.
Deduction approved . " " " '," �•••••••••
�7'T �p7,v9
zo �Z zo _S"�__ zo �_ I zo �
,.o i' r'
Caunty Auditor
property for wrtent year? �,J YesLJ No
20
zo
We ceR'rfy under the penalty of perjury that the above and foregoing infortnation is We and correct and that the applicants was / were
��sident ot Indiana and owner of the aforementioned property on March 1, 20
resident
r.� �'�� �xxan�l, U
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person