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�ei' '" � STATEMENT OF MORTGAGE OR CONTRACT INt7EBTEDNESS
.� FOR DEDUCTION FROM ASSESSED VALUATION
`• . w� / State Form 43709 (R6 / 5-06) � - '
� Presaibed by OepaNnent of Lo�l Govemment Finance
Count Trnvnship Year
INSTRUCTIONS: �LF� �� ZOO�
To be filed in pe�son o� by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 7) Real P�operty: DuAng the 12 months 6e%ie ,lune it o(the year the deducG'on is to be ellective.`-y� ,�!"��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the dedFfc6Brf� ��,tptective.
See reverse side /o� additional instructions and qual�cations. a�BSON COUNTY AUDITOR
see
Taxing Oistrid
�ii(Q � / � —/�1i — G
Assessed value of real property as of
March 1, wrrent year
what is his / her exact share of interest?
����
/ legal'description
'UUV. of //—<)�l�C
MoRgage / Contrad indebtedness
March 1, cunent year
If name on record is different ihan that of applicant, indicate below:
moAgagee or wntrad seller
Address of
seller
Name of assignee or other owner or
� Record number
�Q d �
Page number � /�
as of Is the applipnt the sole legal or equitable
owneR � Yes ❑ No
If owned with someone oth'er than spouse, indicate with whom.
�er and street, city, te, ZIP
mortgage
Address of assignee (numbe� and sGeet, ciry, state, ZIP code) -
Does applipnt own property in any �istriIX?
county in Indiana?
Dra�ti�er N ......
o ... 7....
c����1,�ro.. Co5
.......�5.........
Deduc6on approved in the amow
20
Signalure
20
i�
�u
County Auditor
s the property in queslion:
� Real Property O Mobile Hane (IC 61.1-�
� A ll /�
J
Has this dedudion been requested on
property for wrrent yeaf? � Yes� No
20 _ � 20
Date
cert'rfy under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
ue (ownefs 1 name) Person authorized by duly executed Power of Attomey
�„�. � _, , e, � y, or by IC 6-1.1-12-.07
applipnt
0
Address of authorized person