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��ai � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES —
FOR DEDUCTION FROM ASSESSED VALUATION ou t 7 s p Year
, State Form 43709 (R6 / S-06)
� Presaibed by Department of local Govemment Finance
t ��7
I INSTRUCT/ONS: �l6 ��� Mark
To be filed in person or by mail with the County Auditor o/ the county where fhe property is located. �
Filing Dates: 1) Real Properfy: Dunng the 12 months be%re June Il of the year the deduction i,�t�$88(�t�i1n47Y AUDITOR �
2J Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 of the yea� the deduction is to be effecfive.
See �everse side fo� additional instnictions and qualifrcations.
buyer
Taxing District
Assessed value of real property as of
March 1, wrrent year
no, what is his / her exact share of interest?
If name on record is diiferent than that
of moAgagee or contrad
on reverse side)
Key r�efi�ber / legal description
a.�,-�a-o�- �3oa.-
��s / P�-Z v, i7.� C
Mortgage / Contrad i�
March 1, current year
below:
Record numbe�
Page number �
as or I is me appncantcr7a soie iegai or
owne(? ,f��Yes ❑ No
�O I
If owned with someone other than spouse, indicate with whom.
Address of moAgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amouni of:
20 20 20 09
� -C
Signature
_ �i'aA'K i�
CEN'�R�� � _
��1 �`�y
, ����
What TaxmS
COUNTY AUDITOR
20
County Auditor
20
20
Date
❑ Mobile Home (IC fr1.1
Do��o
s
een requested on
yeaf? � Yes � No
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person