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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Sute Form 43709 (RS ! 4-03)
PiescnGeE by Departmeni ol Local Govemment Finance
INSTROCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the property is located. I'I!�' q q 2��5
Filing Dates:.l) Reaf Property: During the 12 months belore May 11 0( the year fhe deduction is to b�-�IfeCiivL.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the yeai the deduction is to be eRective.
See reverse side for addifional instructions and qualifications. �J� ,�S �
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Applicant (owneror ra buyer- see 2stnctio s n 2verse side).
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Taxing Disirid � Key number / legal description Record number ^�
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%'q� r l � � ` ^� (��-� Pagenumber
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Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year �. March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his 1 her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Hane (IC 61.1-�
�me of mortgagee or contract seller . _
Address o( mortgagee or contract selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, city, state, ZIP code)
Does applicant own propeAy in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount ot
20 _j� 20 _Q�_ 20 � 20 20 20 20
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Signalure � County Auditor Dale
We certify under the penalty of perjury lhat the above and foregoing intormation is true and corred and that the applicants was / were
a resident of Intliana and owner of the atorementioned property on March t, 20
ignature w rs full name) Person authorized by duly executed Power of Atlomey
, or by IC 6-1.1-12-.07
u esident address of applicant Address of authorized person
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