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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
" FOR DEDUCTION FROM ASSESSED VALUATION
�'+ �w� / State Fortn 43709 (R5 / 4-03)
� Prescnbed by Department of Laal Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe�e the property is /ocated.
Filing Dates: 1) Real Property: Dunng the 12 months 6elore May 11 of the year the deduction is to be ��1p�ive. 2 ZOO7
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tAe deduction is to be effective.
See reverse side /or additional instnictions and quali�cations. �aa ��(�,'
01950N EOGNfiV A(1BIi@FI
Applicant (owner or cyat�act buyer - see restripions on feverse sidel
Distrid
Assessed value of real property as of
March t, wrrent year
no, what is his / her exac[ snare of interesl?
If name on record is different than that
mortgagee or contrad seller
Key number / legal description� 88 Q�$ Rewrd number Q�
�-��-on�-toa-oo/.
��q ,� Q f R 4 8' D� Page number �� ^
� � � u �d
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owne(? ❑ Yes ❑ No
(� �, �DD
If owned with someone other than spouse, indicate with whom.
indicate below:
' 1 ( 1 n �
Address of mortgagee or conirad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oT mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appticant own property in any other If yes, what county?
wunty in Indiana?
Deduction approved in the amounl of:
r� i
Signature
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
What Taxing District7 Has this dedudion been requested on
property for current year?� Yes� No
COUNTY AUDITOR
20 ()%� I 20 � I 20 I 20
V �
County Auditor
�
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power oT A�lomey
or by IC 6-1.1-72-.07
� . p Address ofauthorized person
�"� 1 �0'� � � �D O