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°`��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS "
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�-� . FOR DEDUCTION FROM ASSESSED VALUATION
S > State Form 43709 (R3 / 10.00)
Presaibed by Sute Boartl of Ta�c Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
localed during the 12 months before May 11 of the year the deduction is to be effective. See LOOZ 9 Z�30
reverse side for additional instructions and quaiifications.
or contract bu9er - see
Taxing Distrid
rnverse side)
Key number / legal description I Record number �/
D/� �/�� 5 �� Page number �� n
d �/
Assessed value of real 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
no, what is his / her exact
If owned with someone other than spouse, indicate with whom.
' I If name on record is different than that of applicant, indicate below:
of mortgagee or contract selier �
Address of mortgagee or contract seller (numbe and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current year? � Yes ❑ No
Deduction approved in the amount of:
20 �j�` I 20 � I 20 �/�
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COUNTY AUDITOR
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20
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20
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:�:srtify under the penairy of peryury that the above and foregoing information is true and correct and lhat the applicants was / were
.ent of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
re�s of applicant
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person
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