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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 �RS / a-03) ,. �
PresrriGetl Ey DepaRment of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the propeRy is located. A1 3�� 2���F
Filing Dates: 1 J Real Property: During the 12 months before May 11 of the year the deduction is to be e�tiile.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the /year the deduction is to b�eje(fe�t�tive.
See reverse side for additional inshuctions and qualifications. �//�/�,, J'��� ._, l6 , 1i
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�� G1P_�O�ICOIi\T'� AUDiTC� .
buyer-see
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact share of interesl?
It name on record is different than that
of moRgagee or conlrad
side)
Key number / legal description I Record number ��
�/� ��//� _� Page number
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Mortgage / Contrad indebtedness unpaid as of Is the ap�
March 1, wrrent year owne(?
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indicate below:
1 the sol6 legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of moAgagee or contrad seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Is the propeRy in question:
❑ Real Properly ❑ Mobile Home pC 6-1.1
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CaCa�O• • '
Does applicant own property in any olher I If yes, vrhat county? I\Nhat Taxing l
county in Indiana? �
Deduction approved in the amount ot:
20 �/e
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Signature _
COUNTY AUDITOR
20 �� 20 �'_ 20 ��
P -P p
County Auditor
__.,uction been requested on
propeAy for current yeaf��] Yes❑ No
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Date
20
/ We certify under lhe penalty of perjury that the ahove and foregoing information is true and corred and that lhe applicants was! were
resfdent of Indiana and owner of the aforementioned propeRy on March 1, 20
Full resident address of
�S.d'e�
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person