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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
Presaibed by Department of Local Govemmem Finance
Coun Township Year
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INSTRUCTIONS: D E CFile FAaFR�03
To be �led in person or 6y mail with the CountyAuditor of the county where the property is located. �
Filing Dates: 1J Real PropeRy: Dunng the 12 montbs before May 11 of the year fhe deduction is to be�eftective. � L.� � �
2) Mobiie Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year�fhe,de`duction is to be eNective.
See reverse side foraddiUonal inshuctions and qualifications. �1 C13SOP1 G�OU�IT-r ,�uoiTOR 1
Applicant (o�/vrjer or
Taxing District
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on
Key numt(�t / legal
Record number
���_���f�_� Pagenumber
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owner? ❑ Yes ❑ No
Cp Q lAX-/
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on
of mortgagee or contract seller
indicate below:
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and slreet, city, state, ZIP code)
Ooes applicant own property in any oiher I If yes, what counry?
counry in Indiana?
Deduction
20
Signature
Is lhe property in question:
� Real Rnperty ❑ Mobile Home QC 61.1-7)
Drawer NO. ��••�••••••••
What Taxing Dis Q�� I
Card NO. ..� ! . • •���� • •
�(�ag is. °� �c: �4�
COUNTY AUDITOR
in the amount of:
20 20 20 (�� 20 �
P � p
County Auditor
20
Date
20
certify under the penaity of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
fent of Indiana and owner of the atorementioned property on March 1, 20
name)
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
resident address of appiicant ' �Address of authorized person