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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Form 43709 (RS / 4-03)
PresaiDetl by Depariment of Laal Govemment Finance �
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is Iocat�N 0 g Z0�6
Filing Dates: 1) Real PropeRy: Dunng the 12 months 6efore May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th�a�e_ar tl��ction is to be eRective.
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See reverse side !or additional instructions and qualifications. G�ON CO NTY AUDITOh
or contracf buyer
Assessed value of real property as of
March 1, curtent year
If �io, what is his / her exact share of interest?
on re�e� side)
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Key number / legal descriplion Record number �
Or 9- oa g� � Qo Page number ���
MoRgage / Contrad indebtedness unpaid as of Is the applicant the le legal or equitable
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March 1, current year ownef? ❑ Xes ❑ No
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� Ii owned with someone other lhan spouse, indicate with whom.
if name on record is diHerent than that of appli�,ani, indicate beiow:
� me of morigagee or contrad seller
Address of mortgagee or contract seller (number and street, ty, stafe,
N2me of assignee or other owner or holder of mortqaoe
ur assignee (numtrer and strer:!, riti, s�ate, ZIP code)
Does applicant ovm nropeRy in,any
county ir Indiana?
Deduction appro�,
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I). -; y•hat rnunty? bVhat Taxing Disirid?
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SignaWre __._ . ________COUnt Auditor
Y AUDITOR
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s the property in question:
❑ Real Property ❑ Mobile Home QC 61.1
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Has this deduction been requested on
property for current yea�� Yes� No
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Date
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vd� rF-}iPj unA^r Ih� �„+;�aliy Of per;nr: rF.�� fhe above and fomaoino info:maYon is t�P and corted and thal ihe applicanis was / were
'ecioent of Indiana and owner of fhA aforen,entioned propr.rty on March t 20
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�ident ad�t�e: s o( aooG�ant
Person a� AhnnzeA by duly executed Power oi Nttomey
or by IG 6-t. t-12-_O i
authonzed person