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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R4/ 10.07)
PrewiDeO by Deparimenl W Laal Govemment Finance
Count Township Year
INSTRUCTIONS: F�{le�Q�(
To be filed in person or by mail with the County Auditor o/ the county wheie the property is located. MAY G Luu�
Filing Dafes: f) Real PropeRy: During the 12 months be%re May 11 of the year the deduction is to 6eSe/%ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ t ear the de �uc ' �s to e ctive.
See reverse side foradditronal instructions and qualifications. G�gSON COU� Ty pUp170ft
Applicant (owne� or contract buyer- see restrictions on reverse side)
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Taxing Distrid Key number / legal descriplion Record number O�
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Assessed value oi real property as of Morigage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exacl share of interesl? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the propeRy in question:
B"RSaI Property ❑ Mobile Hwne (IC 61.1-�
�e of mortgagee or contrad seller
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Address of mortgagee or conlracl seller (number and st et, ity, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Dislrid? Has this dedudion been requested on
county in Indiana? property for wrrent yea(? 0 Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sig ture County Auditor Date
We certity under the penalty of perjury that the above and foregoing information is true and correct and ihat lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
" ature (owners full n Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fut resident address of applicant Address of authorized person �
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