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��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � •
�s;�� FOR DEDUCTION FROM ASSESSED VALUATION � .-Z'!� �P Year
' « J State Fortn 43709 (R6 / SO6)
� � Aesaibed by Depanment of Loral Gwemment Finance �q N 6 2007
INSTRUCTIONS: �a� ,Fl��rk
To be (iled in pe�son o� by mail with the CountyAuditor of the county where the propeRy is located S�N �OUNTY AUDIfiA�
Filing Dates: 1) Real Property: During the 12 months befoie June �1 0l lhe year the deduction is to�i� e ec rve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eflective.
See reverse side fo� additional instructions and qualfications.
Applicant (owner or contract buyer- s
Taxing istrict , (�
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
vqns on reverse sWe)
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Key number / legal descriptio Record number
a�-ia-o�-3os�—� rs��-a�a ��
�/�, M/ —� Pagenumber ���/�
6�/! j
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current yea��� Q�� � pp owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different than thaf of applicant, in
�me of mortgagee or contrad seller �
Address of mortgagee or contrad seller (number and
assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
below:
state,
Does applicant own property in any other � If yes, what county? What Taxing Distrid?
�I�r�Ar:� 1 � ^.
— Dra�ver N0�6.0. � -�:7.77
� COUNTY AUDITOR
Card NO : :....................
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Signature
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County Auditar
Is the property in question:
❑ Real Properiy ❑ Mobile Home
Has this deduction been requested on
property for curtent yeaR � Yes ❑ No
zo
Date
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We certify under the penalty of peryury that the above and foregoing information is true and correG and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Full
S6vTt+
Person authorized by
or by IC 6-1.1-12-.07
of authorized person