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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'- FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
` � State Form 43709 (R4 / 70-07)
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� Presaibed by Department of Local Govemmeni Finance
INSTRUCTIONS: � � 'File M2rk'' �
To be filed in person or by mail wifh the County Auditor of the county where the property is located. b--��
Filing Dates: 1) Rea/ Property. During the 12 monfhs be%re May 11 of fhe year the deduction is to be-effecti
2J Mo6ile Homes assessed under IC &1.1-7: Between January 15 and Maich 31 of the year the uction i e eflective.
See reverse side for additional instruc6ons and qualifrca6ons. I�� �`� ����
ApplicaM (ownerorcontract b��/e� sG�
Assessed value of real properiy as of
March 1, current year
If no, what is his / her exad share of interesl?
/ legal
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Mortgage / Contract indebtedness
March 1, current year
�po a J�
If name on record is dif(erent ihan that of applicant, indicate below:
of moAgagee or conVad seller
Record number /( �
CJ
D_ �/') Page number ^� /�
I �/ pC �D
unpaid as of Is the appliwnt the sole legal or
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
�
Address of mortgagee or conVact seller (number and street, city, sfate, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (numberand st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
r � ,�
�
Signature
20 ��
Is the property
❑ Real Roperly ❑ Mobile Hane pC 61.1-�
Has lhis dedudion been requested on
property for current year? 0 Yes ❑ No
2� � I 2� � 2� � 2� � ( 20
County Auddor
Date
/ We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
i resident of Indiana and owner of lhe aforementioned property on March 1, 20
executed Power of Attamey
or by IC 6-1.1-12-.07
d IAddress of authorized person
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