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�:STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
`� FQR DEDUCT►ON FROM ASSESSED VALUATION Coun T ip Year
� � �• � �� ! Sute Form 43709 (R5 / d-03� i �!j
i]
� PrescnDed Cy Department o: Local Govemment Finance �,�J
� '
p�T 0 4 200
INSTRUCTIONS: File Maric
To be filed in person or by mail ivith the County Auditor of the county where the property is located.
Filin Dafes:.l Real Pro ert : Dunn the 12 months belore Ma 11 of the ��" ''a�
9� ) P Y 9 y year the deduction is to be:eNecL4e.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the yeaf tbe�dqdycNID7D13Qgbe effective.
. � . . � Glts�v�
See reverse side for additronal�instructions and qualifications.
(owneryfc�onfract buyer- se� resMctions on rev�rse side)
number / legal description Record numbero �
D/�_��/ (! �—� Page numbery a 3
7
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current �year March t, curr year � owne(? � Yes ❑ No
/
lJ
If no, what is his / her exact share of interest?
name on record is different than ihat of applicant, indicate below:
o! mortgagee or contraG
Ii owned with someone other than spouse, indicate with whom.
s the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
Address of mortgagee or contrect seller (number and�2et, city, state, ZIP
(/ %� �-/' �
GGa e/ 2oo$—S�7So
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and streef, city, state, ZIP code) -- - -- i --
Does a licant own ro ert in an other If es, what coun � OS �� 2�
PP P P Y Y r ry. Drawer NO ...... :...........
. requested on
county in Indiana? ' ? Q Yes� No
�
CardNO . .....................
20
/
Signature
approved in the amount of:
� rj'.
couNrv
20 � 20 20
�
County Auditor
20
20
We certiry under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
resident o( In�fia and owner of the afo�entioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
resident address of appliwnt IAddress of authorized person