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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� µ� J State Form 43709 (RS / 4-03) �
Prescn�ea Dy Department o1 Loral Govemment Fina�e
JUN 2 � 2006
INSTRUCTIONS: �
To be filed in person or 6y mail with the County Auditor ol the county where the propeRy is locat�
SON COUNT1F�l�R
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 of the year the deduction is to be eNective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 o/ the year the deduction is to be elfective.
See reverse side for additional instructions and qual�cations.
Taxing
or contracf
�
reverse side)
Key number / legal description Record
���a. 07- yo�-ooa.s s�-o
Page number
�o�J7o '�
Assessed value of real property as of Mortgage Contract indebtedness unpaid as of Is lhe applicant he sole legal or equitable
March 1, current year March 1, current year owneR � s❑ No
�� �O
If ,io, 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 applicant, indicate bek�w:
,me oi moAgagee or contract seller ,
Address of mortgagee or contract seller (nu er and street, city, state, ZIP
Name of
Address
or other owner or holder of mortgage
(number and stiect; city, state. ZIP code)
Does applicant own property in any olh�� � If •���> �••hat county? What 7axing DistriG?
counry ir Indiana? I
CnUNTY AUDITOR
---- ----- - - -- - -- - ---- —
Deduction appro•�ed in the amount nf:
20 �� Tzn ��_ ro _ O�_ zo ao
__�_ _� _ _ � __1� �__1_ ___ _
Signalure _ _.__ _ County Auditor
Is the property in question:
� Propeity ❑ Mobile Hmie pC 61.1-
Has this deduGion been requested on
property for wnent yeaf? � Yes � No
za
Date
�
� We cetiify under ihP p��naHy of per;nry �h�t thP above and fomaoina informaGUn is �ru� and corred and ihal ihe applicanls was / were
resirient of Indiana and owner of thP afnrementioned propeRy o� March 1 20 __
:: d:
�
Person a��thnrizeA by duly executed Power of Htfomey
or by IG 6-1.1-12-.07
Address of authorized person