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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS / 4-03) ' , , , ` '
PrescnDetl Dy Department of local Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Marfc
To be filed in person or by mail wifh the County Auditor of the county where the property is located. I`IAT �[(J� 4
Fiirng Dates: 1 J Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deductl�n i��c�
See reverse side for additional instructions and quali�cations.
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Applicant (owner or ct uyer- see restrictions pn re se side)
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Taxing Dislrict Key number / legal descrip6on Record ber
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, wrrent year March t�rent ye2r - , owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appliwnl, indicate below S� C�E N� -��.. ;n question:
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��ame of mortgagee or contred seller uGE�
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Address of mortgagee or contrad seller (number an street, cit7 ��'�°
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and street, city, s;ate, ZIP code)
Does applicaM own property in any other ( If yes, �.vhat county? I1N;,at Taxing Oistrid? Has this deduction been requested on
county in Indiana? property for current yeaR n Yes❑ No
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COUNTY AUDITOR
Deduction approved in the amouni of:
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SignaWre County Auditor Date
��/ We certify under the penalty of perjury that the above and foregoiny information is true and corred and thal the appiicants was ! were
resident of Indiana and owner of the aforemer,tioned property on March 1, 20
Signatur� owners (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu I resident address of applic� Address of authorized person
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