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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNFss
FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fortn 43709 (RS I 4-03)
PreSCnDetl by Departrmm of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Audito� of the counry whe2 the property
Filing Dates: 1J Real Property: During the 12 months before May 11 0/ the year the deduction is tp� e�eqtiv��6
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ td a th'� Ue uction is to be elfective.
See reverse side Ior additional instructions and quali�cations.
contracf buyer
Assessed Jalue of reg(properiy as Vf /
March 1, curtent year V
If ,io, what is his / her exact share of interest?
If name on record is difterent than
of mortgagee or contract seller
on rever/e side)
Key number / legal
d�,S-�37 ;�
MoRgage 1 Contrad indebtedn�
March 1, current year
aoapo
indicate bek�w:
S
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner �r holder of mortpaoe
Address of assigneP (numberand stree!.
D ra�r•er NO.. �:5.-...� .8 �,�
Card NO . .....................
::��te. ZfP code)
:^hat rvunty?
Deduction appm•�ed m tne amn��„i nt: _� --- --
"' Q�
cs unpaid as o
Q
number O
Page number
Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
Is the property in question:
❑ Real Property ❑ Mobile Horne QC 6�1.
ZIP
bVhat Taxing District? ' Has lhis deduqion been requested on
property for current year? � Yes ❑ No
couNTV tiuoiTOR
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iignaWre —__..---- ---CountyAuditor
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Date
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1h�r. rFrtiFj under!he p.�nalty of per:nr: eF.,� �ne above and foreaoino info:mai�on is }ru� and corred and Ihat ihe applicants waslwere
e�i�ent of Indiana and owner of fho afnrementioned property on March 1. 20
(n�vner's `��c ram, ;
Person a�Rhnrized by duly executed Power of F{�tomey
or by IG 6-t 1-12-.07
ss or�ooncant • 41��- IAddress of authonzed person
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