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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Siale Form 43709 (R4 / 70.01)
Prescribe0 by DepaM�enl W Loral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe2 the properry is located. � E � 1� 2�02
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to b ef(ecNve.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0l th ear the ded c[i� is to be eHective_
See ieverse srde for additional inshuctions and qualificafions. JN��
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Applicant (owner or contract buyer- see res rictions on reverse side)
Taxing Distrid Key number / legal description Record number
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O . Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the soie legal or equitable
March i, current year March 1, current year owne(? �es ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than thaf of applicant, indicate below: Is the properfy in question:
eal Property ❑ Mobile Home pC Cr1.1-�
�me of mortgagee or contraIX seller
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Address of moAgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curcent yeaR 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 20 Q{� 20 20 O p 20�
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ignature County AudRor Date
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and coned and that the applicants was / were
:: resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s full name) Person authorized by duly executed Power of Attomey
�� � � �yb Q � � � or by IC 6-1.1-12-.07 ,
Fu I resident address of appliqnt Address of authorized person
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