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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
� M� J State Fortn 43709 (RS / 4-03)
Presui�ed by Departmem ot Local Govemment Finance
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INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where tha property is
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 0l the year the deduction is to t��t(ecf�v�. 2003
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the vear the deduction is to be ehective
See reverse side !or additronal instructions and qualifications. I/`
/D rincn� Tv AUDITOR
Key nu er / legal descript Record number
1 / — ^ .. ,
� �j�/ , (}� _ O� O�/ �� Page number D
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant 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 exact share of interest? It owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
me of mortgagee or contract seller
'Address of mortgagee or contrect seller (number and st2ef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces applicant own property in any other if yes, what counry? What Taxing District? Has this deduction been requested on
county in Indiana? property forcurrent year?❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� zo _� za zo 01T> zo �$_ zo 0 zo
� T �
gnature County Auditor Date
'� We certify under the penalty ot perjury ihat Ihe above and foregoing information is true and carrect and that the applicants was I were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nat e(owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
1 esid d ress f licant Address of authorized person
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