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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S° �/ State Fortn 43709 (RS I 4-03)
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� PrespiEed Ey Department of Local Gdvemmem Finance _ _
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INSTRUCTIONS: I� F' �File Mark�.'
To be filed in person or by mail with the CounryAuditor of the county where the property is located. 1i ,� •
FiGng Dates: 1) Real Property: Durrng fhe 12 months beto2 May 11 0/ the year the deduction is ro be eB� cti�e.� 9 n
2) Mobile Homes assessed under lC 6-1.1J: Between January 15 and Maich 2 of the year th��deductidnQs�o be eHective.
See reverse side for additional instructions and qualifications.
Taxing Distrid
6uyer-
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Assessed value oi real property as of
March 1, current year
no, what is his / her exact share of inlerest?
side)
Key number / legal
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Mortgage / CoNrad inc
March 1, cunent year
Iso
as
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Page number
Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contract seller _ �
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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 mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �_ 20
�Y�10 0+4-
Signature
� 20�1l0 20�� 20
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County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Horne QC G1.1-�
Has this dedudion been requested on
property for current yea(? � Yes ❑ No
20 �"L 20
P
Date
certify under the penalty of peryury that the above and foregoing intormation is true and correct and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power
or by IC 6-7.1-72-.07
Fuii q23�dent address of a{,¢li�nt � � �Address of authorized person