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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
�• I State Fwm 43709 (RS / 4-03)
� Prescn�etl by Depenment of Lotal Govemmem Finance
INSTRUCTIONS:
io De nletl In person or by mail with the County Auditor of the county where the property is lowted. !1!� T 1'� z��3
Filing Dates: i) Real Property: During the 12 mon[hs before May 11 of the year the deduction is to be eltechVA
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. J
GIB/��NTY AUDITOR
Applicant (o er ont uyer - see restnctio s reverse side)
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Taxi District ey number gal description Record number
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Page number �
Assessed value of I property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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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 the property in question:
❑ Real Properry ❑ Mobile Home (IC E1.1-7)
�e of mortgagee or contract seller \ 1 r\ `,� �
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Address of mortgagee or contrect seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of moRgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any oiher If yes, what county? What Taxing District? Has this deduction been requesied on
county in Indiana? property for curtent year? ❑ Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 � 20 � 20 �_ 20
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Signature County Auditor Date
/ We certiTy under the penalty of perjury that the above and foregoing infortnation is true and corcect and that the applicants was I were
ident of Indiana and owner of the aforementioned property on March 1, 20
S�gi �ature (owner's lull name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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