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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stete Fwm 43709 (R6/ 5-06)
Presaibed by Department of l.ocal Gwemment Fina(xe
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INSTRUCTIONS: APR F�e ��507
To be filed in person o� by mail with fhe County Audito� of the county whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months befoie ,lune 11 of the year the deduc6on is to be effective.
2) Mobile Homes assessed unde� IC 6-1 J-7: Between January 15 and March 2 of fhe year the t�y�tio�e effective.
See reverse side lo� additional instruc6ons and qual�cations. OIB90N CO NU TY AUDITOR
Applicant (owner or o 6acf buye� - see stn'c6o s n reve�se side
Taxing District number/legal escription Record number O/7
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as oi Is the applicant the sole legal or equitable
March 1, curtent year March t, current year owner? Q Yes � No.
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I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diRerent than that of applicant, indicate below: Is the property in question:
❑ Real Properly � Mob�le Home (IC 61.1-7)
�e of mortgagee or conVact seller
Address of moRgagee or contract seller (number and street, city, stafe, ZIP
Name oi assignee or other owner or holder of mortgage
Address of assignee (numbe� and strset, city, state, ZIP code)
Does appliqnt own property in any other If yes, what counry? What Taxing District? Has this deduc6on been requested on
county in Indiana? property far current year? Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 0 20�_ 20 Q� 20 20 20 20
P
Signature County Auditor Date
I i We certify under the penalty of perjury that the above and foregoing iniortnation is We and conect and that the applicants was / were
�sid t oi Indiana and owner of the aforementioned property on March 1, 20
i ture owners ( ll Person authorized by duly executed Power of Attomey
or by IC 6-1.1-� 2-.07
u r ident addre s of applicant Address of authorized person
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