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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNFS�
FOR DEDUCTION FROM ASSESSED VALUATION
Sute Form 43709 (R6 / S06)
Presai6ed by Department of Laal Govemment Finarxe
INSTRUCTIONS:
To be liled in person o� by mail with the CountyAuditor o! the county where the prope�ty
Filing Dates: 1) Real Property: During the 12 months 6eloie ,lune �1 of the year the deduction is �t�e e(fe8tivj�n6
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of hfe`yeaf the 6e��uction is to be effective.
aee reverse s�oe ror aoomona� rnsuucuons ano quauncanons.
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Applicant ( r or contrsct buye� - see rictions o reverse side) "
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Taxing Distrid Key nu er / legal escription Record number J�
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_ 1 � � /� „ n D//—oo➢��j ,Q(7 Pagenumber �
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Assessed value of real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole egal or equitable
March 1, current year March 1, current year owneft ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? It owned with someone other lhan spouse, indicate with whom.
If name on record is different than Ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC E1.1-�
�me of moAgagee or contrad seller ����
Address of mortgagee ��-conVact seller (number and st2et, aty, sfafe, ZIP
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Name of assignee or
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Address of assigne ,S�v�o . /�(��
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Does applicant rnn . ��"••. , Whal Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? �" property for current year?Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of: ,
20 � 20 n� 201Z 20 20 20 20
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Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing informalion is true and corcec[ and thal ihe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature owners (ull name) Person authorized by duly exewted Power of Attomey
� � or by IC 6-1.1-12-.07
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Full et sident address o applipnt Address of authorized person
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