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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' FOR DEDUCTION FROM ASSESSED VALUATION
+ J State Fwm 43709 (RS / 4-03) '�
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P25aibed by Depanment ot Local Gtivemment Finance
Coun Township Year
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INSTRUCTIONS: ' �UN O �F�I�A�rk
To 6e filed in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dafes: 1) Real Property: During the 12 months before May 11 0( the year the deduction is to be �ltective.
2J Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 ot the yeai the d�ctioo is to be eHective.
See reverse side for additional instructions and qualifications. ��BSON COUN7Y U�;70R
Applicant (owneror
Taxing
Assessed value of real property as of
March 1, wrrent year
If no, whaf is his / her exacl share of inleresl?
Key �i j�mber / legal
Record number
1-, � 200 �
'O / � _ �J � � � � _ �' � Page number ' '' �
tN- _�
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or e
March 1 rrent year ownef? ❑ Yes ❑ No
�'300� ,
If owned wifh someone other than spouse, indicate with whom.
name on record is diHerent than that of applicant, indicate below:
of mortgagee or contraIX seller
Address of mortgagee or contrar.t.�d�^-'— "" et, city,
__�_'
Name . . •
Drawer NO ................
Addre: /���� .�(f,�.. �e�
Card 1O• �w
Does a�
county i
ZIP
_, ..��o� county? I What Taxing District?
Deduction approved in the amount of:
20 (l � 20 �� 20 �'
P � P
Signature
COUNTY AUDITOR
20
County Auditor
20
s the praperty in
❑ Real Property ❑ Mobile Home
Has this deduc[ion been requested on
property for current year? �] Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner o( the aforementioned property on March 1, 20
ture (owners fulf name)
�sident ad�l�
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person