Mortgage_Ritter��
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R6 / SO6)
Prescnbed by Department of Lo<al Govemmenl Finance
INSTRUCTIONS: � � �
To be /iled in person or by mail with the County Audito� ot the counfy where the pe y is located.
Filing Oates: 1) Real Property: Dunng the 12 months be%re June Il of the year the ded y� f9 �ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma��oithe year the deduction is to be effecfive.
See reverse side for additional instn�cfions and qualifrcations. �ryy� a�. �Q
v'( pUNTY AW�TOR
Applicant (owner or contrac u er - see restrictions on reverse side
Taxing Distrid . Key number / legal description Record number
�t _' �� � � ` ^/�, � � Page number �/ �
lP O� `%
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or squitable
March 1, wrrent year March 1, current year owner? ❑ Yes 0 No
�
If no, what is his / her exact share of interesl? If owned with someone other than spouse; indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Hortie QC 61.1-�
me o1 mortgagee or contraIX seller �i � )
.. -. _. . � ��•VV ' � __ � _ �.. .
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP _ _ ___ __ _-__
Name ot assignee o� �� D�_ ��� 3 S
Address of assignee
Does applicant own � ���/�� Q� U ��Rs� - duction been requested on
county in Indiana? cunent yeaR� YesO No
Deduction approved ��'��'�� �C �
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zo �� ' zo
Signature ' County Audifor Date
�� We certify under the penalty of perjury that the above and foregoing intormation is true and corred and that the applicants was / were
-esident of Indiana and owner of the aforementioned property on March t, 20
Si atur own s/ull a Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full ident addr s of a plicant ddress of authorized person
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