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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fortn 43709 (RS / 4-03) � �
P'escnDetl Dy Departmeni of Loral Gtivemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Oates: 1) Real Property: During the 12 months be(ore May 11 0! the year the deduction is to be eft��e`� � 2��4
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the/ year the deduction is to be e((ective.
See reverse side for additional instructions and qualifications. I/
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Apptican (o nerorcont tbuyer- erestrictions erseside
Tauing Distrid Key number / legal de ption Record number �` '�
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o / — O � � - � Page number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applican�t th`e sole legal or equitabie
March 1, wrrenl year March 1, current year owne(? y� res ❑ No
��o�.
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 diHerent than ihat of ap�licant, indicate below: is the pr.opeRy in question:
�� Property ❑ Mobile Home QC G1.1-n
�ame o! moRgagee or conlraU seller �j
i �
Address of mortgagee or contrad seller (number and street, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, slate, ZIP code)
Does applicant own property in any other If yes, what counly^ � 1Nhai T2.xing District? Has this deduction been requested on
county in Indiana7 i property for current year? �] Yes� No
COUN �Y AUDITOR
Deduction approved in the amouni of:
2o Q� 20 �_ zo O 20 _Q � zo �� 20 20
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Signature County Auditor Date
�I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
: resident of Indiana and owner of the aforementioned property on March 1, 20
Si ture (owners full name) . n �, Person authorized by duly executed Power of Attomey
�O �,�,� or by IC 6-1.1-12-.07
u resident address of applicant• Address of authorized person