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!i 4 STATEMENT OF MORTGAGE OR CONTRACTINDtBTEDNESS
'�i' '' '= FOR DEDUCTION FROM ASSESSED VALUATION - Co ow Year
,
� w ! State Fwm 43709 (R6 / 5-06)
Presaibetl by �epartment af Laal Gwemment Finance
INSTRUCTIONS: File Maric
To be �led in person or by mail with the County Auditor of the county where lhe propeRy is located. . �
Filing Dates: 1J Real Property: During the 12 months befoie ,lune Il of the year the deduction is to be g�g¢�j�� CouN� �pI���
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and March 2 o/the year the deduc6on is fo ctive.
See reverse srde for additional instructions and qualifrcations. �
Appl' t(owner or contract buyer - see restrictions on reverse side)
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Taxing Dist Key number / egal description oO / Record number
� a6 -i7-o�_��o� aoo7.
�– � �/ Page number /' / ph
`J O V
Assessed va ue of real pro rty as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year March 1, current year owne(? "� ❑Yes 0 No �
�8 9a n . .
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicatewith whom.
If name on record is different than ihat of applicant, indicate below: _ Is the property in question:
❑ Real PropeAy ❑ Mobile Horrie (IC 61.1-�
e of mortgagee or wntrad seller
C. S �j �x- . ��- .
Addresa of moRgagee or contracl seller (number and st2et, city, state, ZIP ,, .
Name of assignee or other owner or holder of mortgage �
Address of assignee (number and sh --` "^--'°� ' .
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Does appliqnt own property in any c �� �O� �—�--1 � gQ iested on
county in'Indiana? Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �1$_ 20 �_ 20 20 20 20 20
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Signature Counfy Auditor Dale
e ceAify under the penalty of perjury that lhe above and foregoing information is true and correct and that the applicants was / were
.esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (own �(ull name) � Person authorized by duty executed Power oi Attomey
� or by IC 6-1.1-12-.07
Ful r sident address ot applicant ` Address ot authorized person
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