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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C
� J State Form 43709 (RS / 4-03)
�«
� Presaibetl by Department ol Loral Govemmani Finance �
�RUCTIONS:
e filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months belore May 11 of the year the deducfion is to 6e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ye
See reverse side for additional instructions and qualificafions.
Applicant (pj�vR€r�r/���er - see
� ( �
Taxin istnct -'
// /r- � ����/ O , �
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
name on record is
reverse
��� P � �- �� irr�� y.
Key number legal description T—
O/J�- o136z
Mortgage / Contract indebtedne:
March 1, current year
applicant, indicate below:
N�� � �
.i n
G�as��
Record number � �
_ OD Pagenumber / �
s unpaid as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
'�40 �
owned with someone other than spouse, indicate with whom.
Name of mortgagee or contra �e� ��i//� �e //� �(�
U�
�ress of mortgagee or contreci seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
street, city, state, ZIP code)
�
',����s
Mobiie Home (IC 61.
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes❑ No
Deduction approved in the amouni of:
20 �
20 O � I 20
�
COUNTY AUDITOR
�
County Auditor
� �:
,f
20 � �
P
Date
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
;, resident of Indiana and owner of the atorementioned property on March 1, 20
(owners
%
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person
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