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�� ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�°- : FOR DEDUCTION FROM ASSESSED VALUATION
'� j Sfate Form 43709 (R3 / 10.00) �
_� Presaibetl Dy State Board W Taz Commissioners
Instructions for filing:
To be filed in person orby mail with lhe County Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduclion is to be effective. See
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Count Township Year .
�� File��
8
NOV 2 fi 2001
reverse side for additional instructions and qualifications.
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Applicant (owner or contract buyer- see iestnctions on ieverse side) V v�� �"�
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Ta�cing District ey number / legal description Record number O �
� O �� � Page number ��p
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Assessed value of real property as of . Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than thai of applicant, indicate below:
P o( mortgagee or contract seller
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Address of mortgagee or contrad selle number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own real property in any If yes, what wunty? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current year?�� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� � 20 20 20 0 20 6 E 20 �J _ 20 �_ �
�5 � C� � P
Sig ature County Auditor Date
�NA r�Rify under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned propeAy on March 1, 20
Signa owners (ull name) � /' Person authorized by duly executed Power of Attomey
� o �, � or by IC 6-1.1-12-.07
Fu reside t address of app' nt � Address of authorized person
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