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iai� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
j` ' FOR DEDUCTION FROM ASSESSED VALUATION To Year
�'• State Form 43709 (R6l 5-06) � �
� Presaibed by Departmen� of Lopl Gwemment Finance
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INSTRUCTIONS: �F!ile" Mark
To be filed in person or by mail with the County Auditor of the county where the p�operty is located. �%j ,��+�
Filing Dates: 1J Real P�operty: Dunng the 12 months before ,lune Il of the year the deduction is to be ef/e�T Y pUDITp R
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/rYti��tai�h tlucLOn �s to be effective.
See �everse srde for additional insln�ctions and qualifications.
Applicant (owner or cont ct buyer - see restrictions on reverse side)
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Tauing Dislrid Key number / legal description Record number
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�o-/Ff-U7-/U 3 -a�, � � � Page number
Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i,'current year March 1, current year owneR �es � No
� Q�
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 different than that of applicant, indicate below: Is lhe property in question:
eal Property ❑ Mobile Home QC G1.1-�
�me of moRgagee or contract seller n �. _
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Address of mortgagee or contred seller (numb r and street, city, st
Name of assignee or other owner or holder of mortgage
Address of assignee'(number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? properiy for curtent yeaR � Yes O No
COUNTY AUDITOR
Deduction approved in lhe amount of:
20 � 20 � 20 20 20 20 20
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Signature County Auditor Date
�We certify under the penalty of perjury lhat the above and foregoing informalion is true and corred and that the applicants was / were
esideni of Indiana and owner of the aforemenlioned property on March 1, 20
Si nature (owners /ull name) � Person authorized by duty executed Power of Attorney
� or by IC 6-1.1-12-.07
uil resident address of applicant Address ot authorized person