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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
��w I State Fortn 43709 (R5 / 4-03)
� PrescnDed by Departmant of Local Govemment Finance
iNSrRUCnoNS: OCT 1 0 Z006
File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months be%re May 11 of the year the deduction is to be eff �
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 o(the��r��Cl �t�iQn���effective.
See reverse side for additional instructions and qualifications. ,
contracf buyer-
axing District / �
�i�u��
��U��Q a��� �
Assessed value of real property as of Mortgage / Contract ir
March i, current year March t, current year
J
Ii no, what is his / her exact share of inlerest?
If name on record is diHerent lhan lhat of applicant, indicate below:
of mortgagee or conlract seller
Address of mortgagee or contrad selier (number and street, city, stafe; ZIP
of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
Does applicanf own propeRy in any other I If yes, what county?
county in Indiana?
app
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Signature
Drawer NO...�-h��••••••
5a 39
Card NO. ........1......�......
,� �� � Ot�lJ. /
� � �
number
number
unpaid as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
with someone other than spouse, indicate with whom.
What Taxing Distrid?
UNTY AUDITOR
County Auditor
20
question:
❑ Real Pmpe�iy ❑ Mobile Home QC 6-1.1
Has this deduction been requested on
property for wrrent year? � Yes 0 No
Zo
Date
zo
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�ppucant IAddress ofauthonzed person
�ee �� ,