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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESc
s FOR DEDUCTION FROM ASSESSED VALUATION
� I State Form 43709 (R5/4-03)
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P2saiEeC by Depertment of Local Govemment Financa
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INSTRUCTIONS:
To 6e filed in person or 6y mail with the Counry Auditor of the counry where the property is
Filing Dates: 1J Real Property: During the 12 months before May 11 of the year the deduction is to b� �Hective. nj�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the�ar the �e�tlt't�on is to be eflective.
See reverse side for addi[ional instrucfions and qualifications. /� �/� n n
(owner
/ legal
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�/ / � ,( JD��I �.� Page number �
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year owner? ❑ Yes ❑ No
name on record is diHerent than that of applicant, indicate
Name ot mortaaaee or contract seller
of mortgagee or
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP
ciry,
If owned with someone other than spouse, indicate with whom.
Does applicant own property in any other If yes, what county? Whal Taxing District?
county in Indiana?
COUNTY AUDITOR
)eduction approved in the amount of:
zo D zo D zo o� 20 0� zo
, � �
�ignature County Auditor
s the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
Has this deduction been requested on
property for curtent year? ❑ Yes ❑ No
zo
Date
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I/ We ce ' under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
`resi nt of Indiana and owner of the aforementioned property on March 1, 20
applicant
or by IC 6-1.1-72-.07
Address a horize rson�� � � ��
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