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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfaro Fortn 43709 (RS I 4-03)
PrescriDed by Department of Loral Guvemment Finance
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Coun Township Year
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INSTRUCTIONS: JANile Mark
To be fifed in person or 6y mail with the CounryAUditor of the county where the property is located. 1`� 200 t
Filin Dafes: 1 Real Pro e Dunn the 12 months before Ma 11 0/ the Y
9 ) P nY 9 y year the deduction is to 6e ef/ective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yeai fhe deduction is to be effective.
See reverse side for additional insfructions and qual�cations.� ��.Y ��_ -., ,_ ���
. . � -U,."T�G�
(owner or conItract bi
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- see restrictions on
Assessed value ofrealproperty as of
March 1, wrrent year
If no, what is his / her exad share of interest?
on record is different ihan thai ot
of mortgagee or contract seller
/legal
Record number
— /U
G�J 5- o 3 9 9 �.� ?age number
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owne(? � Yes ❑ No
�3�od
Ii owned with someone other than spouse, indicate with whom.
below:
Is the properfy in question:
�eal Properiy ❑ Mobile Home pC 61.
Address of mortgagee or wntred seller (number and st2et, city, state, ZIP � � �'--- �— -
Name of assignee or other owner or holder of mortgage DCaWer N�.. :`• ���• ••••••
Address of assignee (number and st2et, city, state, ZIP code) . Card \T •••I• �� . L•N. "'
�83, � bo. °°—��F
Does applicant own property in any other If yes, what county? What �CC� ��� •�""'1 � r iested on
county in Indiana? property for current year?Q Yes� No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 0
Signature
20 U✓ 20 Q(L 20 �
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County Auditor
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20
We certify under the penalty of perjury lhat the above and foregoing infortnation is true and coned and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
name)
executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person