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e rt�'�,f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�°� .= FOR DEDUCTION FROM ASSESSED VALUATION �
'� � SUte Form 43709 (R3l 10.W)
Presrlibed Dy State Board of Taz Commissionere
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during Ihe 12 months before May 17 oi the year the deduction is to be eNective. See
reverse side for additional instructions and quaiifications.
Applican ner or cont2¢{ uyer- see
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Taxing Distrid
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Assessed value of real property as of
March t, curtent year
If no, what is his / her exact share of inte
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rtions on 2verse side) /� G��s��" ""
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Key numb r/ legal description Record number O/
OO�—OO�/�_ DO Pagenumber � ��/
Mortgage / Contrad indebiedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
If name on record is different lhan lhat of applicant, indicate below:
of mortgagee or contract
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If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contred seller (number and sGeet, city, state, ZIP
Name of assignee or other owner or hoider of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own real property in any I If yes, whal wunty? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current year?❑ Yes❑ No
Dedudion approved in the amount of:
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COUNTY AUDITOR
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County Auditor Dal
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certify under the penalty of perjury that the above and foregoing information is irue and correct and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.7-12-.07
Address of authorized person
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