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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (Ra / 10-01)
Prescribed Dy DepaNnenl of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or 6y mail with the County Auditor o( the county where the propeRy is located.
Filing Dates: 1) Real Property: During fhe 12 months be%ie May 11 0l the year the deductron is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and Maich 31 0/ fhe yea�the�deducG�s�t� elf�e.
See ieverse side /or additional instructions and qualifrcations. �
Applicanl (ovmerorcontract buye - e restnctions on reverse si ' JHIV 4(��
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Taxing Distrid Key number / lega escnption Record nu" v
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Ass ssed value of real p p y as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, currenl year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is different than thal of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mo�le Home (IC &1.1-�
Name of mortgagee or contraU seller ^
Address of mortgagee or conVad seller (number and street, city, state, ZI
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and street, city, slate, ZIP code) .
Does applicant own property in any other If yes, what county? What Taxing District7 Has ihis deduction been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sign ture �j County Auditor Date
I/ We certify under the penalty of perjury lhal the above and foregoing inforznalion is true and correct and lhat ihe applicants was / were
esident diana and owner of the aforementioned property on March 1, 20
r�er'� (ull name / Person authorized by duly executed Power of Attomey
�G rj v or by IC 6-1.1-12-.07
ull resident address of applicant Address of authorized person
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