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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
�s �«. / State Form 43709 (RS / 4-03) �
Prescnbed by Department ot Local Gtivemment Finance /
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INSTRUCTIONS: File Mark
To be �led in person or by mail with the County Auditor ot the county where the property is located. .
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduction is to 6e effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction is to be effective.
See reverse side Ior additional insfructions and qualiTcations.
�owner or
Taxing District
Assessed value of real
March 1, current year
ouyer- see restn
. . ... �. � �. ...
as of
no, what is his / her exact share of
on reverse side)
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�r��rr.a.s�
Key number / legal descriptio Record number
�?G /o asa�-a�sZS�ba-�a,i �
/'\/'1� _ O �-1 I /� � Page umber ,
(�l `-1 lJ Q p � � �.
MoAgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR �es ❑ No
I 5 (� �;oc� .
If owned with someone olher lhan spouse, indicate with whom.
If name on record is difterent ihan that of applicant, indicate
mortgagee'or contract
Address of mortgagee or contrad seller (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
state,
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
� � � x � � �,� _ 1 � COUNTY AUDITOR I �
Deduction approved in the amount of:
20 �•� I 20 d�
P
Signature
20 Qg_ 20 20
P
County Auditor
Is t
❑
property in question:
❑ Mobile Home (IC 6�1.7
Has this deduction been requested on
property for current year?�] Yes� No
20
Date
20
We certify under the penalfy of perjury that the above and foregoing information is true and correcl and that lhe applicants was / were
resident of Indiana and owner of the aforementioned propeAy on March 1, 20
full
address of applicant
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Person authorized by
or by IC 6-1.1-72-.07
of authorized person