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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
f FOR DEDUCTION FROM ASSESSED VALUATION
� I State Fwm 43709 (RS / 4-03)
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� Prescn�eE by Depertment o( Laral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe CountyAuditor of the county where the propeRy is
Filing Dates: 1J Real Property: During the 12 months before May 11 0/ the year the deducti
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ye�Fjie �
See reverse side lor additional insfructions and qualifications.
or contrect 6uyer
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Assessed value of real property as of
March 1, currenl year
restrictions on
Key number / legal description
u
is to
� �9_ �3�vv ��i� Pagenumber �, L
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or
March 1, arrent year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diflerent than that of applicant, indiwte below: Is lhe property in question:
❑ Real Property ❑ Mobile Home (IC Et.t-7)
�me of mortgagee o�act seller ] L'' �- •
. �-/�/n/c� ✓�i i (/� �lOc��6/fC E � ��/Ti o•✓s -
Address of mortgagee or contract seller (number and street, city, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZlP code)
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
20
approved in the amount
20
COUNTY AUDITOR
20 � 20 Q 20
yo P
County Auditor
Has this deduction been requested on
property for curtent year? ❑ Yes� No
20 � 20
�
�ate
We certify under the penaity of perjury that the above and foregoing information is true and conect and that the applicants was I were
(esident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
of authorized person