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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4 / 10-01)
Prescribed by Depanment of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audifor of the counfy where the property is located. a P p Q 5 2002
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the yea� the deduction is to be effectiJe.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of year the d du ion is to be effective.
See reverse srde (or additional instructions and quali�cafions. �/
GIESON COUV*v q�iDiTOR
Applicant (owne� or contract buyer- see restrictions on reverse side)
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Taxing Dislrid Key number / ie I description Record number
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Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as o( Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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Ii no, whal is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of appiicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
e of mortgagee or contract seller
ddress of mo gagee or contrad seller (number and stree , cify, state, Z
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Districl? Has this deduction been requesled on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 ��� a 20 �_ 20 20 0� 20 Q(� 20 0% 20 6 P
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Sig ature CY-1 County Auditor Date
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�We certify under the penalty of perjury lhal lhe above and foregoing information is true and corred and that the applicants was / were
:sident of Indiana and owner of the aforementioned property on March 1, 20
Signat wners full name) � Person authorized by duly executed Power of Attorney
�� or by IC 6-1.1-12-.07
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F I resident addre f applicant 'F ''� Address of authorized person
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