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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Shate Form 43709 (RS / 4-03)
PrasaiEeO by DepaM1ment of lo;al Goa�emment Financa
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.N 0 �/ q g ZO
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to b'e eflec`tiVe. �5
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0) the year the deduction is to be elfective.
See reverse side for additional instructions and qual�cations. .' �.�� ,Q�
n ^ GI5SON COUN7Y q DITOR
or conriaomnirer - see
Dislrid
Key number / legal description � Record
number � / , / �
.f
Assessed value of real property �as of Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curcent year March 1, wrrent year owneR ❑ Yes ❑ No
1 oaotrv
If no, what is his / her exact share of interest? Ii owned with someone other fhan spouse, indicate with whom.
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If name on record is difterent than that of appliwnt, indicale below: Is lhe property in question:
of mortgagee or contract seller
Address of mortgagee or coniract selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeef, city, state, ZIP code)
Does apoliwnl own property in any other I If yes, what wunty? What Taxing Distrid?
county i
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� (,ilALC.1S � COUNTY AUDITOR
Deducf �� , � /t�—]
20�L
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Signature
20 20
—1-
County Auditor
❑ Real Property ❑ Mobile Home QC 61.1-�
nas �nis aeauczion oeen reques�ea on
property for wnent year? � Yes ❑ No
20
Dale
20
We certify under the penalty of pe�jury that the above and (oregoing information is true and corred and lhat the applicants was / were
esidenl of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of appfl�ant Address of authorized person
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