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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
'•• �M� J State Fortn 43709 (RS / 4-03) : ' � '
� P25cnbed by Depanment of Lofal Govemmeni Finance
iNSrRUCrioNS: �UN. 0 � 2006
Fde Mark
To be filed in person or by mail wiih the County Auditor of the county where the property is located. �
Filing Dates: 1) Real Pioperty: Dunng fhe 12 months before May N o/ the year the deduction is to 6e eAectiv�d
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0l the yearGh��f���ti��fn �eg�'ve.
I
See reverse side for additional instructions and qualifrcations.
(owne� or contract
Taxing Distrid
����
see
Assessed value oi real property as of
March t, cunent year
If no, what is his / her exact share of interest?
/ .�-
Key number / legal description Record number
oi9- �a �a� � 9 0�
Pa e number �� �
MoRgage / Contract indebledness unpaid as of Is lhe applicant the sole legal or equitable
March 1, currenty�ar owner? ❑ Yes ❑ No
name on record is different ihan that of applicant,
me of morigagee or contraIX seller
Address of mortgagee or contracl seller
of
or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP
below:
Does applicant own property in any other I If yes, what rf+..���^—
county in Indiana? _ "
� ����,..�r-� �
��1Zi�l���N �-'
Deduction approve �
o� -���
2� �
p
Signature _
GV _V� I 2O � 2O
�/ �
If owned with someone other than spouse, indicate with whom.
slate, ZIP
County Auditor
Vhat Taxing District?
DITOR
�
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
' p�-y���
Has this dedudion been requested on
property for current yeaf? [� Yes� No
20
Date
20
We ceAify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
�
full nam �
1,P� � .
�5 of applicant
�_
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
Address of authorized person