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�y STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
i� � FOR DEDUCTION FROM ASSESSED VALUATION Co own i I+ . ear
�� w�` / SUte Form 43709 (R6 / 5-06)
� Presvibed by Department of Loml Gwemment Finance
To beR/UC�TION �on or by mail wifh the Counfy Audito� of fhe county where the property is locafed. ���M'- "�
Filing Dates: 1) Real PropeRy: During the 12 months before ,lune 11 of fhe year the deduction is to be �� COUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduc6on is to be eRective.
See reverse side for addftional instruc6ons and qual�caGons.
Assessed va�le oi real
March 1, current year
6uyer -�Se�'restrictions on reverse
.
� Key number/ legal description Record�number
a�-�� 0�-.3°0-00� d�a-
�a� Page number
as of Mortgage / Contract indebtedness unpaid as of Is the appli�
March 1, curtent year owner?
t the sole legal or
❑ Yes � No
03 /G %QD .
If no, what is his / her exact share oi interest? If owned with someone other fhan spouse, indicate with whom.
If name on record is different than that oi applicant, indicate below: Is the property in ques6on: �-
❑ Real Property ❑ MoMle Home QC 6�1.1-7)
� of mortgagee or conVact seller �1�
Address of mortgagee or contract seller (number and stieet, city, state, ZIP
oT assignee or other owner or holder oi mortgage
Address of assignee (numbe� and stieet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
)eduction approved in the amount of:
20 20�� 20
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UI':1�1'CI' ��....�"Y.T.....
What Taxing D� C;1 t'(� � 0. ••••�'���' Vo
�,�, c�ld�d
� o1i�v� KSO. °��
COUNTY AUDITOR
20
County Auditor
20
20
Date
20
certify under the penalty of perjury that the above and foregoing infortnation is We and correci and that the applicants was /were
ient oT Indiana and owner of the aforementioned property on Marcli 1, 20
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or by IC 6-1.1-12-.07
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