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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTiON FROM ASSESSED VALUATION
State FOrm 43709 (R4 ! 10-01)
Prespibea by pepartment ot Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. 0 p� 1 c� 10�3
Filing Dates: 1) Real Property: Dunng the 12 months be%ie May 11 0/ the year the deduction is to be e7�ec ive.
2) Mobile Homes assessed under IC 61.1-7: BeKveen January 15 and March 31 0/ /he year� the /deduction is to be e(/ective.
See reverse side (oradditional instructions and qualifica6ons. �;� .. �S- 1��`1
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GieSON co��r:'t' ��UDITCF.
Applicant (o erorcontrdct bu - restrictions on reversg side) .
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Taxing Di tnd Key number / legal escription R rd number '^
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicani, indicate below: Is the property in question:
❑ Real Property ❑ Modle Home QC 61.1-�
�me of moAgagee or contrad seller �
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Address of mortgagee or contrad selier (number and st2et, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
��/ We certify under the penalty of perjury that the above and foregoing infortnalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatu (owners full me) Person aulhorized by duty execuled Power of Attomey
/ or by IC 6-1.1-12-.07
Full sident addr f applip 1 Address of authorized person
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