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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
-� State Porm 43709 (R6 / 5-06) - .
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��• Presaibed by Departmenl of Local Govemrtrenl Fi�nce �� �� 1� .
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INSTRUCTIONS: no� 0 1 �ile�Mark
To be filed in person or by mail wrth the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before ,lune Il o/ the year the deduc6on is to be effective. �
2J Mobile Homes assessed under IC 6-1J-7: Between January 15 and Maroh 2 of the year the deduc`tion is to be e8ective.
See reverse srde fo� additional instiuclions and qual�cations. G�gSO� C�U,l7� l:D'T�c.
Applicant erorcontractb�yer s e stn
Taxing District
�/X �
As ssed v e oi real r erty as of
March 1, current year
Ii no, what is his / her exad share of interesl?
on
�� • �/aU
Record
� (� Page ni
Mortgage / Contred indebtedness unpaid as of Is lhe applicant lhe sole legal or equitable
March 1, curtent year ,a owneR ❑ Yes ❑ No
7 Vc� ,5'���°
If owned wiih someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
, me of mortgagee or conUaIX seller
Address of mortgagee or conVad selier (number and st2e city, state, Z�
Name of assignee or other owner or holder of mortgage
(number and street, city, state, ZIP code)
Is the property in quesGon:
-- �.r�.R�al Proosty ❑ MoWe Home pC Cr1.
moc.Jl2Er�, Ga2� cJ _
OE�Pr��1NA �J -
�6"���y
Does applicant own property in any other I If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in lhe amount
20 20 fi�
( �
Signature
COUNTY AUDITOR
20� 20 20
P
County Auditor
Has this deduction been requested on
property for wrrent yeaf? � YesO No
20
Date
20
We certify under lhe penalty of peryury that the above and foregoing information is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
vfiers full name
address of applipnt
Person authorized by duly executed
or by IC 6-1.1-12-.07
person