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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fwm 43709 (R6 / 5-06)
Presoibed by Depariment of Loral Gwemment Finance
INSTRUCTIONS:
To be /iled in person or by mail with the County Auditor of the county where the property is located. V� l j 1 2�07
Filing Dates: i) Real Property: Dunng the 12 months before June I1 0( fhe year fhe deduction is to be effective.
� 2J Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the ye�� �� is to be e/%ctive.
See reve�se side for additional instructions and qualificalions. GIggON COUNT y qUD�TOR
Applicant (owne� or contract bu r- see restnctions o v rse side)
Taxing Disirid _ Key number / legal d scription Record number Q
�2 '�� � Page number
V O�
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curcent year March 1, wrrent year owneR ❑ Yes ❑ No
aG- - -o -000.� �o�s�
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 different than that of applicant, indicate below: Is the property in question:
❑ Real Property p Mobile Home QC Fr1.1-�
�me of moRgagee or contract seller Q
Address o( mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for curcent yea(T �] Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
Z�� 2� � 20 2� 20 20 2�
Signature County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and ihat the applicanls was / were
� resideni of Indiana and owner of the aforementioned propeRy on March 1, 20
Signature (owner's full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of appticant Address of authorized person