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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Tawnship Yea
�s �� / State Form 43709 (RS I 4-03)
� PrescnDed by Department of Local Govemment finance
INSTRUCTIONS: � Fi� ark
To be filed in person or 6y mail wiih the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the year the deductiontisttq 6 e e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and MarFh 2 0l the y�ea�h��uction is to be eflective.
See reverse side for additional instructions and qualifications. � t7
� ���SON Cni iur7�i �
buyer-
Assessed value of real property as of
March 1, current year
it no, what is his / her exact share of interest?
on
Key number / legal description Record number D�
D/9-�0 �a sLa� Page number �O
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, c�t year owneR ❑ Yes ❑ No
�-/ ���
If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than thaf of applicanl, indicate betow:
'ame of mortgagee or ntract seller �
Address of mortgagee or contrad seller (number and treet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, sfate, ZIP code)
Is the property in question:.
❑ Reai Properly ❑ Mobile Home QC 61.
Does applicant own property in any other If yes, what wunty? What Taxing Distrid? __- I Has this dedudion been requested on
county in Indiana? '" property for current yeai? � Yes � No
Deduction approved in the amounf of:
zo zo D.�' 20
Signature
�• v�~• •••• -
Dra" er � • (.��.ci�
CacaN� �o �
, � � P
Counry ..aditor
Date
zo
/ We certify under the penalty of perjury that lhe above and Toregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
of a�pqlicant � �� . IAddress of authorized person