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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNEff�
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (RS / 4-03)
PrescriEetl by Oepanment of local Govemment Finance
�TRUCTIONS:
o be filed in person or by mail with the County Auditor of [he county where the property is
Filing Dates: 1) Real Property: During the 12 months before May 11 01 the year the deduction is to be elf�(ry�. 3� 20�3
2) Mobile Homes assessed under IC 6-1.1-7: Be(ween January 15 and March 2 0l the year tAe deducbon is to 6e effective.
See reverse side (or additional instrucfions and quafi�cations.
buyer-see
Assessed value of real property as of
March 1, cunent year
If no, what is his
If name on
exact
mortgagee or contract seller
reverse
Key numb�i�( legal descriplion
0 � �i - D33�'
Mortgage / Contract indebtedness
March 1, curtent year
�pDO-�d
applicant, indicate below:
/� f;IRSON COIW? t'
Record number
�-
Page number (� �y
unpaid as of I Is the applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
mortgagee or contract seller (number and street, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage
(num6er and street, city, state, ZlP code)
Does applicant own property in any other If yes, what county?
county in Indiana? '
Deduction approved in the amount of:
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Signature
20 �,� � 20
VJhat Taxing District?
COUNTY AUDITOR
20 � I 20 _�_
�
County Auditor
Is the property in question:
❑ Reai Properry ❑ Mobile Hane (IC E1.
Has this deduction been requested on
property for curtent year? ❑ Yes ❑ No
20 �_ 20
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Date
We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was I were
�sident of Indiana and owner of the aforementioned property on March 1, 20
(owners full
Person authorized by duly executed Power of Attomey
or by IC E1.1-12-.07
person