Mortgage_Hamm�' STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
j '. -�w� J Suta Form 43709 (RS / 4-03)
� Prescn�etl Oy Department ol local Govemment Finance
INSTRUC710NS: - File Mark
To be filed in person or by mail with the County Auditor of the county whererythe property is located. y� �� ��
Filing Dates: 1) Real Property: Dunng lhe 12 months before May 11 of the year the deduction is to b c e.
2J Mobile Homes assessed under IC 6-7.1-7: Between Janua 15 and March 2 o/the e r tA o ctive.
See reverse side for additional inshuctions and qualifications.
JUN 1 0 2005
Applicant(ownerorcontracf yer seci're ' insonreversesi ) �n'_��
� N CO�UNTY
Taxing �stnd Key number / legal de iption Record number
\ j� � O� V � O��P��� Page number
v � o
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, wrrent year March 1, wrrent year owner? ❑ Yes ❑ No
�
If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Properiy � Mobile Hmie (IC 67.1-�
�me of�mortgagee or conVaIX selier .
Address of mortgagee or contract seller (numb and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? � property for current year?0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 20 �_ 20 20 20 20
� � 1
Signature County Auditor Date
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
ign re (owners lull name) Person authorized by duiy exewted Power of Attomey
� � or by IC 6-1.1-12-.07
ull resid n address of applicant Address of authorized person