Mortgage_Reed (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION Coun 7ownship Year
�'• «� ✓ State Form 43709 (RS / 4-03) . � � � /
� Prestn�ed Dy Depanment of Local Gtivemment Finance O Q y
INSTRUCTIONS: MAR 2 2F�Q,�ric
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 01 the year the deduction is to be� t�ve.�
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeA'r th�Buc�s to be effective.
See reverse side for additional instructions and qualifications. CaIBSON COUNTY AUDITOR
Applicant
Taxing D
see re�sfris(io�s on�everse side)
number / legal description � Record number
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Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, wrrent year owne(? ❑ Yes ❑ No
If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
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If name on record is different than thal of appliwnt, indicate betow: Is the op rty in question:
❑ Real Property ❑ Mobile Home (IC 6-1.1
��ne of mortgagee or contracl seller ,(�y
0 Jl IAaa�o ��J �.�.i�i1,�—
Address of mortgagee or contract seiler (num er ab nd street, city, state, ZIP ��Q
Name of assignee or
Address
owner or holder of mortgage
(num6er and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
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Deduction app DraWei NO, ��,,,,,
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Signature
What Taxing District?
urY auoiTOR
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County Auditor
Has this deduclion been requested on
propeRy for current year? � Yes� No
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Date
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certify under the penalry of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
applicant
Person authorized by duly executed Power o( Atlomey
or by IC 6-1.1-12-.07
of authorized person